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UNAIDS 2019 | REFERENCE

UNAIDS
DATA
2019
CONTENTS

Foreword 2

State of the epidemic 5

Global and regional data 16

Eastern and southern Africa 21


Country tables 34

Western and central Africa 75


Country tables 88

Asia and the Pacific 137


Country tables 152

Latin America 209


Country tables 222

Caribbean 255
Country tables 268

Middle East and North Africa 289


Country tables 300

Eastern Europe and central Asia 339


Country tables 350

Western and central Europe and North America 379


Country tables 388

Annex on methods 455


FOREWORD

The AIDS epidemic has put a spotlight on the many fault lines in society. Where there
are inequalities, power imbalances, violence, marginalization, taboos and stigma and
discrimination, HIV takes hold.

The AIDS epidemic is changing: in 2018, more than half of all new HIV infections were
among key populations—sex workers, people who use drugs, gay men and other men
who have sex with men, transgender people and prisoners—and their partners.

Globally, new HIV infections among young women aged 15–24 years were reduced by
25% between 2010 and 2018. This is good news, but of course it remains unacceptable
that every week 6000 adolescent girls and young women become infected with HIV.
The sexual and reproductive health and rights of women and young people are still too
often denied.

Despite the scale of the challenges and the miles we must still travel together in the
AIDS response, I am hopeful. The AIDS response has demonstrated what is possible
when people organize and assert their rights. Around the world, people living with HIV
and civil society have raised their voices and exerted leadership.

When communities organize and people empower each other, oppression can be
replaced by rights and access to HIV services can be accelerated. Peer-to-peer
counsellors, community health workers, door-to-door service providers, grass-root
activists and networks of people living with or affected by HIV all have key roles to
play in the response to HIV. As this report shows, community leadership in the AIDS
response helps to ensure that HIV services are relevant to, and reach, the people who
need them the most.

The world has committed to achieving the 2030 Agenda for Sustainable Development.
As part of that, governments must protect and uphold the human rights of everyone.
As the eyes and ears of the AIDS response, communities play a critical role in holding
decision-makers to account and demanding political leadership.

For me, the AIDS response is about people—the young women who don’t know how
to keep themselves HIV-free, the men who won’t or can’t seek out health care, the
transgender people who are discriminated against and the hundreds of thousands of
people who die each year, even though HIV is preventable and treatable.

It is in our collective power to overcome the barriers that all too often stand in the
way of better health—barriers such as user fees and other hidden costs, harmful laws,
stigma and discrimination, lack of knowledge and gender-based violence.

2
UNAIDS DATA 2019

FOR ME, THE AIDS RESPONSE IS ABOUT PEOPLE—


THE YOUNG WOMEN WHO DON’T KNOW HOW TO KEEP
THEMSELVES HIV-FREE, THE MEN WHO WON’T OR CAN’T
SEEK OUT HEALTH CARE, THE TRANSGENDER PEOPLE
WHO ARE DISCRIMINATED AGAINST AND THE HUNDREDS
OF THOUSANDS OF PEOPLE WHO DIE EACH YEAR, EVEN
THOUGH HIV IS PREVENTABLE AND TREATABLE.

While considerable progress has been made, there is a risk that we will lose
momentum. If the world is to be on track to end AIDS by 2030, there must be adequate
and predictable financing for development. But, for the first time since 2000, the
resources available for the AIDS response globally have declined.

Ending AIDS is a life-saving investment that pays for itself many times over. Increases
in donor and domestic funding are crucial. And the Global Fund to Fight AIDS,
Tuberculosis and Malaria must be fully funded at its next replenishment.

We have the knowledge and tools we need to end AIDS. We cannot change the virus,
but we can change inequalities, power imbalances, marginalization, taboos and stigma
and discrimination. We can change behaviours and societies.

The change we need requires strong collective efforts by both governments and
communities. Success is being achieved where policies and programmes focus on
people, not diseases—policies and programmes that are designed with communities
and that respond to the way that people live their lives.

This edition of UNAIDS data shows the results of some of those successes, but also the
challenges that remain. It contains the very latest data on the world’s response to HIV,
consolidating a small part of the huge volume of data collected, analysed and refined
by UNAIDS over the years. The full data set of information for 1990 to 2018 is available
on aidsinfo.unaids.org.

Gunilla Carlsson
UNAIDS Executive Director, a.i.

3
STATE OF EPIDEMIC

FIGURE 2.1  HIV prevalence, adults (aged 15–49 years), by sub-national level, sub-Saharan Africa, 2018

HIV prevalence (%)

30

25

20

15

10

Note: Grey = sub-national data not available.

Source: UNAIDS special analysis, 2019.

4
UNAIDS DATA 2019

STATE OF
THE EPIDEMIC

AT A GLANCE
Gains continue to There has been Gains in eastern More than half of An epidemic
be made against steady progress and southern Africa new HIV infections transition metric
the epidemic, but in the reduction are driving global in 2018 were among suggests that
those gains are of AIDS-related progress. In much key populations a diverse group of
getting smaller deaths, but efforts of the rest of the and their sexual 19 countries are on
year-on-year. to reach the 2020 world, there are partners. the path to ending
target for reductions worrying setbacks AIDS. Many more
in HIV infections are in key countries and countries are not.
clearly off-track. entire regions.

Overall progress against the HIV epidemic is measured over the last decade, and more gradual progress in the
through the calculation of estimates of new HIV reduction of new HIV infections.
infections and deaths from AIDS-related causes.
Countries input the best available HIV surveillance These gains are getting smaller year-on-year, and the
and programmatic data into mathematical models deadline for reaching the 2020 targets agreed by the
to produce annual epidemiological estimates, and United Nations General Assembly is getting closer and
UNAIDS then aggregates country estimates into closer. Efforts to reduce HIV infections are clearly off-track,
regional and global ones. and while reductions in AIDS-related deaths are stronger,
mortality-reduction targets could also be missed.
Each year, newly available data from countries and
improvements in the models lead to adjustments in The global picture obscures a wide diversity of trends
these estimates—not just year-on-year, but across the among countries and regions. In recent years, there
entire curve of annual estimates, from the current year have been worrying rises in annual HIV infections
back to the beginning of the epidemic. New evidence and AIDS-related mortality in key countries and
about the impact of antiretroviral therapy on mortality entire regions. The largest reductions in annual HIV
has been used to refine assumptions in the model, infections and AIDS-related deaths have occurred in
and this has produced lower estimates of AIDS-related the region hardest hit by the epidemic: eastern and
deaths than the estimates from the previous year (see southern Africa. Progress in the rest of the world,
annex on methods). where HIV infections are predominantly among key
populations, is considerably slower. The majority of
Trends, however, remain similar: there has been steady global infections in 2018 were among key populations
global progress in the reduction of AIDS-related deaths and their sexual partners.

5
STATE OF EPIDEMIC

A one third decline in AIDS-related deaths to 54% of the world’s people living with HIV. AIDS-related
mortality in the region declined by 44% from 2010
The annual number of deaths from AIDS-related illness to 2018, to 310 000 [230 000–400 000]. By comparison,
among people living with HIV (all ages) globally has fallen AIDS-related deaths in western and central Africa
from a peak of 1.7 million [1.3 million–2.4 million] in 2004 declined by 29%, to 160 000 [110 000–230 000] (Figure 2.3).
to 770 000 [570 000–1 100 000] in 2018. Since 2010, AIDS-
related mortality has declined by 33%. Reaching the Outside of sub-Saharan Africa, there has been
2020 milestone of fewer than 500 000 deaths will require a 20% decline in AIDS-related deaths, to 300 000
further declines of about 135 000 per year (Figure 2.2). [230 000–420 000] (Figure 2.4). AIDS-related deaths
in the eastern Europe and central Asia and Middle
The global decline in deaths has largely been driven by East and North Africa regions have risen by 5%
progress
TITLE OFinTHE
eastern and southern Africa, which is home
ARTICLE and 9%, respectively, over the eight-year period.

FIGURE 2.1 Number of AIDS-related deaths, global, 1990–2018 and 2020 target
Number of AIDS-related deaths

AIDS-related deaths Target

Source: UNAIDS 2019 estimates.


PART 1 | PART TITLE

AIDS-related deaths Target

FIGURE 2.2 Number of AIDS-related deaths, FIGURE 2.3 Number of AIDS-related deaths,
eastern and southern Africa and western and central regions outside sub-Saharan Africa, 1990–2018
Africa, 1990–2018
Number of AIDS-related deaths
Number of AIDS-related deaths

FIGURE 2.3A Number of AIDS-related deaths, global, 1990–2018 and 2020 target

0 0

Eastern and southern Africa Regions outside sub-Saharan Africa


Western and central Africa Regions outside sub-Saharan Africa

Source: UNAIDS 2019 estimates. Source: UNAIDS 2019 estimates.


Eastern and southern Africa

6 Western and central Africa

FIGURE 2.4.2A Number of AIDS-related deaths,


UNAIDS DATA 2019

New HIV infections declining gradually As is the case with AIDS-related mortality, the reduction in
new HIV infections between 2010 and 2018 was strongest
The annual number of new HIV infections globally in eastern and southern Africa (28% decline). Progress
continued to decline gradually in 2018. Since a was also made in the Caribbean (16% decline), western
peak of 2.9 million [2.3 million–3.8 million] new and central Africa (13% decline), western and central
infections (all ages) in 1997, year-on-year declines Europe and North America (12% decline), and Asia and
have grown smaller. The annual number of new the Pacific (9%). However, the annual number of new HIV
infections (all ages) since 2010 has declined from infections has risen in eastern Europe and central Asia
2.1 million [1.6 million–2.7 million] to 1.7 million (29% increase), the Middle East and North Africa (10%
[1.6 million–2.3 million] in 2018, a 16% reduction that increase) and Latin America (7% increase). Regional gains
leaves the world far off the 2020 target of fewer than and setbacks combine to produce a flat 10-year trend in
500 000
TITLE OF new infections
THE ARTICLE(Figure 2.5). new infections outside of sub-Saharan Africa (Figure 2.6).

FIGURE 2.4 Number of new HIV infections, global, 1990–2018 and 2020 target
Number of new HIV infections

New HIV infections Target

Source: UNAIDS 2019 estimates.


PART 1 | PART TITLE

New HIV infections Target


FIGURE 2.5 Number of new HIV infections, eastern and southern Africa, western and central Africa, and
regions outside sub-Saharan Africa, 1990–2018
FIGURE 2.1A Number of new HIV infections, global, 1990–2018 and 2020 target
2 500 000
Number of new HIV infections

2 000 000

1 500 000

1 000 000

500 000

Eastern and southern Africa Western and central Africa Regions outside sub-Saharan Africa
Eastern and southern Africa Regions outside sub-Saharan Africa Western and central Africa
Source: UNAIDS 2019 estimates.

7
STATE OF EPIDEMIC PART 1 | PART TITLE

FIGURE 2.6 Trends in new HIV infections, by region, 2010–2018


HIV DATA

400 000 120 000


Number of new HIV infections

Number of new HIV infections


350 000 +7%
100 000
-9%
300 000
80 000
250 000
200 000 60 000
-5%
150 000
-18% 40 000
100 000
20 000
50 000
0 0
2010

2011

2012

2013

2014

2015

2016

2017

2018

2010

2011

2012

2013

2014

2015

2016

2017

2018
Asia and the Pacific Asia and the Pacific without Latin America Latin America without Brazil
China and India
1 200 000
Number of new HIV infections

Number of new HIV infections


25 000

1 000 000
20 000 +10%
800 000 -28%
15 000
600 000
-21%
10 000 +33%
400 000

200 000 5000

0 0
2010

2011

2012

2013

2014

2015

2016

2017

2018

2010

2011

2012

2013

2014

2015

2016

2017

2018
Eastern and southern Eastern and southern Africa Middle East and Middle East and North Africa
Africa without South Africa North Africa without Iran (Islamic Republic
of) and the Sudan
180 000 350 000
Number of new HIV infections

Number of new HIV infections

160 000 +29% 300 000


140 000 -13%
250 000
120 000
100 000 200 000
80 000 150 000 -23%
60 000
100 000
40 000 -4%
20 000 50 000
0 0
2010

2011

2012

2013

2014

2015

2016

2017

2018

2010

2011

2012

2013

2014

2015

2016

2017

2018

Eastern Europe Eastern Europe and central Asia Western and Western and central Africa
and central Asia without the Russian Federation central Africa without Nigeria

Source: UNAIDS 2019 estimates.

Varied country-level trends can be obscured by regional infections instead of a 7% increase. Similarly, the
averages, especially in regions where there are one or exclusion of China and India from Asia and the Pacific
FIGURE 2.12 Trends in new HIV infections, by region, 2010–2018
two countries that account for a majority of new HIV results in a more rapid 18% decline in new infections.
infections (Figure 2.7). In most cases, larger countries In some cases, removing countries with larger epidemics
report lower performance than their smaller regional reveals poorer performance in the rest of the region.
neighbours. A prime example is eastern Europe and The exclusion of South Africa from eastern and southern
central Asia, where the regional trend, excluding the Africa results in a shallower decline of 21% (compared to
Russian Federation (which accounted for 71% of the 28%), and excluding the Islamic Republic of Iran and the
region’s new HIV infections in 2018), is a 4% decline Sudan in the Middle East and North Africa shows that
instead of a 29% increase, or in Latin America, where new HIV infections in the other countries of the region
excluding Brazil results in a 5% decline in new HIV increased by 33% (compared to 10%).

8 8 12
TITLE OF THE ARTICLE UNAIDS DATA 2019

More than half of new infections are among FIGURE 2.7 Relative risk of HIV acquisition by
key populations and their sexual partners subpopulations aged 15–49 compared to adults
aged 15–49 in the total population, global, 2018
Key populations make up a small proportion of the
general population, but they are at extremely high risk Transgender people
of HIV infection. Available data suggest that the risk of
HIV acquisition among gay men and other men who Gay men and other men who
have sex with men
have sex with men was 22 times higher in 2018 than it
was among all adult men. Similarly, the risk of acquiring
People who inject drugs
HIV for people who inject drugs was 22 times higher
than for people who do not inject drugs, 21 times
higher for sex workers than adults aged 15–49 years, Sex workers
and 12 times higher for transgender people than adults
aged 15–49 years (Figure 2.8). 0 5 10 15 20 25

Relative risk
Strong progress in settings with high HIV prevalence
Note 1: Relative risk compares the incidence of two populations.
in eastern and southern Africa, where HIV is
Incidence for sex workers, people who inject drugs and
predominantly transmitted within the general transgender people was estimated and then divided by the
population—combined with a mixture of progress and global incidence of HIV among adults aged 15–49, estimated
using the Spectrum models. Incidence for gay men and other
setbacks in lower prevalence regions—has seen the
men who have sex with men was estimated and then divided
global distribution of new HIV infections in 2018 cross by the global incidence of HIV among male adults aged 15–49.
a notable threshold: the majority of global infections Note 2: Transgender people estimates are derived only in the
were among key populations and their sexual partners. Asia and the Pacific, Caribbean, Latin America, and western
and central Europe and North America regions.
(Figure 2.9) Note 3: Relative risk is interpreted as follows: sex workers have
21 times greater risk of acquiring HIV than adults aged 15–49
Gay men and other men who have sex with men in the total population.
accounted for an estimated 17% of new HIV infections Source: UNAIDS special analyses using Spectrum 2019 results and
globally, including more than half of new HIV infections 2019 Global AIDS Monitoring submissions, supplemented by data
from published literature.
in western and central Europe and North America, 40%

FIGURE 2.11A Relative risk of HIV acquisition by


subpopulations aged 15–49 compared to adults
aged 15–49 in the total population, global, 2018

9
11
15–49 years), by population group, global, 2018

STATE OF EPIDEMIC
TITLE OF THE ARTICLE

in Latin America, 30% in Asia and the Pacific, 22% in FIGURE 2.8 Distribution of new HIV infections (aged
the Caribbean, 22% in eastern Europe and central Asia, 15–49 years), by population group, global, 2018
18% in the Middle East and North Africa, and 17% in
western and central Africa.
Sex workers People who inject
6% drugs
People who inject drugs accounted for an estimated 12%
12% of global infections, including 41% of new HIV
infections in eastern Europe and central Asia, 37% of
Gay men and
new infections in the Middle East and North Africa, Remaining other men
and 13% in Asia and the Pacific. Sex workers accounted population who have sex
46% with men
for 6% of global HIV infections, ranging from 14% in
17%
western and central Africa to less than 1% in western
Transgender
Transgender women
and central Europe and North America. Transgender women
women made up a small amount of new HIV infections 1%
globally, but they accounted for 5% of new HIV Clients of sex workers and sex
infections in the Caribbean and 4% of new infections partners of other key populations
18%
in Latin America and western and central Europe and
North America.
FIGURE 2.9B Distribution of new HIV infections Sex workers
FIGURE 2.9 Distribution of new HIV infections
(aged 15–49 years), by population group, eastern (aged 15–49 years), by population group, eastern
People who inject drugs
and southern Africa, 2018 and southern Africa, 2018
UNAIDS DATA AVAILABLE
People
with who
AT AIDSinfo Gay men and other men Sexwho have sex
workers men
inject drugs
3% 8%
The data in this document are just a sample of Transgender women Gay men and
other men
the data available from UNAIDS. Additional who have sex
Clients of sex workers and sex partners of other
data presented in spreadsheets, maps and with men
key populations
graphs are available at aidsinfo.unaids.org. 4%
Remaining population
These include: Clients of sex
workers and sex
 Estimates of new HIV infections, AIDS-related partners of other
key populations
deaths and numbers of people living with Remaining
10%
population
HIV by different age groups and by sex. 75%

 Additional Global AIDS Monitoring


indicators on prevention, mother-to-child
transmission, 90–90–90 targets and stigma
and discrimination.

FIGURE 2.9C A Key Population


Distribution of newAtlas
HIVofinfections
maps with the FIGURE 2.10 Distribution of new HIV infections
latest available
(aged 15–49 years), data on
by population key populations
group, (aged 15–49 years), by population group,
at increased risk
western and central Africa, 2018of HIV infection. western and central Africa, 2018
An HIV financial dashboard that brings
 
together into a single platform more Sex workers
than 85 different indicators on HIV 14%
financial resources. People who
inject drugs
 A database of policy indicators collected 8%
Remaining
from countries using the National population
Commitments and Policy Instrument. 36%
Gay men and
 Subnational data for selected countries other men
who have sex
with men
 Comparable data over multiple years 17%
and across countries, which can also Clients of sex workers and sex
be extracted to spreadsheets for partners of other key populations
further analysis. 25%

10
13
(aged 15–49 years), by population group, Asia (aged 15–49 years), by population group,
and the Pacific, 2018 Latin America, 2018
UNAIDS
PART 1 |
DATATITLE
PART 2019

FIGURE 2.11 Distribution of new HIV infections FIGURE 2.12 Distribution of new HIV infections
(aged 15–49 years), by population group, Asia (aged 15–49 years), by population group,
and the Pacific, 2018 Latin America, 2018

Sex workers Sex workers


3% People who
8% inject drugs
Remaining People who 3%
population inject drugs Remaining
22% 13% population
35%

Gay men and


other men
Gay men and who have sex
Clients of sex other men with men
workers and sex who have sex 40%
partners of other with men Clients of sex workers
key populations 30% and sex partners of
25% Transwomen women
Transgender other key populations Transwomen women
Transgender
2% 15% 4%

FIGURE 2.13 Distribution of new HIV infections FIGURE 2.14 Distribution of new HIV infections
(aged 15–49 years), by population group, (aged 15–49 years), by population group, Middle
Caribbean, 2018 East and North Africa, 2018

Sex workers Remaining


6% People who population Sex workers
inject drugs 5% 12%
2%
Gay men and Clients of sex
other men workers and sex
Remaining who have sex partners of other
population with men key populations
53% 22% 28%

Transwomen
Transgender women
5%
People who
Clients of sex workers and sex Gay men and other men who inject drugs
partners of other key have sex with men 37%
populations 18%
12%

FIGURE 2.15 Distribution of new HIV infections FIGURE 2.16 Distribution of new HIV infections
(aged 15–49 years), by population group, eastern (aged 15–49 years), by population group, western
Europe and central Asia, 2018 and central Europe and North America, 2018

Remaining Remaining
population Sex workers Sex workers
population
1% 7% 12%
0.1%
0% People who
Clients of sex inject drugs
workers and sex 11%
partners of other Clients of sex
key populations workers and sex
29% partners of other
key populations
22%

Transgender
women
Transwomen
People who 4% Gay men and other men
Gay men and other men inject drugs who have sex with men
who have sex with men 41% 51%
22%

Source: UNAIDS special analysis, 2019.

11
14
STATE OF EPIDEMIC
TITLE OF THE ARTICLE

FIGURE 2.17 Ratio of new infections to people living with HIV, global and by region
(incidence:prevalence ratio), 2000–2018

Global Caribbean
Carribean

30 30
Incidence:prevalence ratio

Incidence:prevalence ratio
25 25

20 20

15 15

10 10

5 5
3 3
0 0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Incidence:prevalence ratio Target value Incidence:prevalence ratio Target value
Incident prevalence ratio
Target value

Eastern Europe and central Asia Middle East and North Africa
Incidence prevalence ratio Target value
30 30
Incidence: prevalence ratio
Incidence:prevalence ratio

25 25

20 20

15 15

10 10

5 5
3
0 0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Incidence:prevalence ratio Target value Incidence:prevalence ratio Target value

Western and central Europe and North America Asia and the Pacific
Incidence prevalence ratio Targe value Incidence prevalence ratio Target value
30 30
Incidence:prevalence ratio
Incidence:prevalence ratio

25 25

20 20

15 15

10 10

5 5
3 3
0 0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

Incidence:prevalence ratio Target value Incidence:prevalence ratio Target value

12
5 Incidence prevalence ratio Target value Incidence prevalence ratio Target value
UNAIDS
PART 1 |
DATATITLE
PART 2019

Epidemic transition

Recent trends in new HIV infections and AIDS-


Eastern and southern Africa
related mortality can only show part of the story
30 of a country or regional HIV response. For example,
the 2010 baseline for 2020 targets hides strong gains
Incidence:prevalence ratio

25
made by many countries before 2010 (compared
20 to countries that scaled up their HIV responses
more recently). Epidemic transition metrics have
15 been developed by UNAIDS and its partners as
complementary measures that countries can use
10
to better track their progress towards ending AIDS
5 as a public health threat.
3
0
One such metric, the incidence-prevalence
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
ratio, uses the number of new HIV infections
and the number of people living with HIV within
Incidence:prevalence ratio Target value a population to produce the inverse of the average
duration of time a person lives with HIV in an
epidemic that remains stable over many years.
Western and central Africa An epidemic transition benchmark of 3.0%—three
Incidence prevalence ratio Target value HIV infections per 100 people living with HIV per
30 year—corresponds to an average life expectancy
Incidence:prevalence ratio

after infection of 30 years (1). At this average life


25
expectancy, the total population of people living
20 with HIV will gradually fall if the country is below
the 3% benchmark. However, if the number of new
15 infections per 100 people living with HIV per year is
10
greater than three, the population of people living
with HIV will grow over time. The 3.0% benchmark
5 thus combines two desirable conditions: long,
3
healthy lives among people living with HIV and
0
reductions in new infections.
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

The global incidence-prevalence ratio has declined


Incidence:prevalence ratio Target value from 11.2% in 2000 to 6.6% in 2010 to 4.6% in 2018,
reinforcing the conclusion that important progress
has been made against the epidemic. Despite
Latin America this, the world is not yet on track to end AIDS as
Incidence prevalence ratio Target value a public health threat by 2030. Western and central
30
Europe and North America, where treatment
Incidence:prevalence ratio

25 coverage is generally high and a comprehensive


set of HIV prevention options are available to a
20
large percentage of people at risk of HIV, had
15 an incidence-prevalence ratio of 3.1% in 2018,
meaning that the UNAIDS benchmark has nearly
10 been met in this high-income region. Performance
in other regions ranged from 3.9% in eastern and
5
3 southern Africa, 4.6% in the Caribbean, 5.4% in
0 both Latin America and Asia and the Pacific, 5.5%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018

in western and central Africa, 8.0% in the Middle


East and North Africa, and 9.0% in eastern Europe
and central Asia (Figure 2.18).
Incidence:prevalence ratio Target value

Source: UNAIDS 2019 estimates.

13
Incidence prevalence ratio Target value 6
TITLE
STATEOF
OFTHE ARTICLE
EPIDEMIC

TABLE 2.1 Incidence:prevalence ratio, by country, 2018

Botswana, Burkina Faso, Burundi, Cambodia, Denmark, El Salvador, Germany, Italy, Kenya, Mauritania, Nepal,
0–2.99
Norway, Portugal, Rwanda, Singapore, Spain, Thailand, Viet Nam, Zimbabwe

Argentina, Australia, Bahamas, Cameroon, Cabo Verde, Central African Republic, Colombia, Côte d’Ivoire,
Democratic Republic of the Congo, Dominican Republic, Eritrea, Estonia, Eswatini, Ethiopia, France, Gabon,
Guatemala, Guyana, Haiti, Honduras, Israel, Japan, Lao People’s Democratic Republic, Lesotho, Liberia,
3.0–4.99
Libya, Luxembourg, Malawi, Mexico, Morocco, Myanmar, Namibia, New Zealand, Nicaragua, Niger, Panama,
Papua New Guinea, Peru, Romania, Senegal, Somalia, South Africa, Sri Lanka, Suriname, Togo, Uganda,
United Republic of Tanzania, Zambia

Algeria, Angola, Armenia, Barbados, Belarus, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Bosnia
and Herzegovina, Brazil, Chad, Chile, Congo, Costa Rica, Croatia, Cuba, Djibouti, Ecuador, Equatorial
Guinea, Finland, Gambia, Georgia, Ghana, Guinea, Guinea-Bissau, Hungary, Iceland, Indonesia, Iran (Islamic
5.0–9.99
Republic of), Ireland, Jamaica, Jordan, Kuwait, Kyrgyzstan, Latvia, Lebanon, Malaysia, Mali, Mauritius,
Mongolia, Mozambique, Nigeria, Oman, Paraguay, Republic of Moldova, Serbia, Sierra Leone, South Sudan,
Sudan, Syrian Arab Republic, Tajikistan, Tunisia, Ukraine, Uruguay, Yemen

Afghanistan, Bangladesh, Bulgaria, Egypt, Kazakhstan, Madagascar, Montenegro, North Macedonia,


10 and above
Pakistan, Philippines, Uzbekistan

Source: UNAIDS 2019 estimates.

Eighteen countries achieved the 3.0% benchmark Less encouraging are the number of countries that
(Table 2.1), suggesting that the HIV responses in these remain at 5.0% or above: in total, there are 70 such
countries are on the path to ending the AIDS epidemic. countries, including 13 that have a ratio above
The diversity of regions, income levels and epidemics 10.0%—a level that is associated with increasing
within these countries should be cause for hope: hyper- HIV infections and large percentages of people
epidemics, such as those in Botswana and Zimbabwe, living with HIV in these countries being denied
are being brought under control, as are a range of antiretroviral therapy.
more concentrated epidemics. Another 48 countries
have incidence-prevalence ratios between 3.0% and
4.9%, suggesting considerable progress.

9 14
UNAIDS DATA 2019

REFERENCES
1. UNAIDS Science Panel. Making the end of AIDS real: consensus building around what we mean by “epidemic control.” Geneva:
UNAIDS; 2018 (http://www.unaids.org/sites/default/files/media_asset/glion_oct2017_meeting_report_en.pdf, accessed 4 July 2019).

15
GLOBAL AND
REGIONAL DATA
Global summary of the AIDS epidemic  2018

Number of people Total 37.9 million [32.7 million–44.0 million]


living with HIV Adults 36.2 million [31.3 million–42.0 million]
Women (15+ years) 18.8 million [16.4 million–21.7 million]
Children (<15 years) 1.7 million [1.3 million–2.2 million]

People newly infected Total 1.7 million [1.4 million–2.3 million]


with HIV in 2018 Adults 1.6 million [1.2 million–2.1 million]
Children (<15 years) 160 000 [110 000–260 000]

AIDS-related deaths Total 770 000 [570 000–1.1 million]


in 2018 Adults 670 000 [500 000–920 000]
Children (<15 years) 100 000 [64 000–160 000]

Global estimates for adults and children  2018

People living with HIV 37.9 million [32.7 million–44.0 million]

New HIV infections in 2018 1.7 million [1.4 million–2.3 million]

AIDS-related deaths in 2018 770 000 [570 000–1.1 million]

16
UNAIDS DATA 2019

About 5000 new HIV infections (adults and children) a day  2018

 About 61% are in sub-Saharan Africa

 About 500 are among children under 15 years of age

 About 4400 are among adults aged 15 years and older, of whom:
─ almost 47% are among women

─ about 32% are among young people (15–24)

─ about 20% are among young women (15–24)

Global estimates for children (<15 years)  2018

Children living with HIV 1.7 million [1.3 million–2.2 million]

New HIV infections in 2018 160 000 [110 000–260 000]

AIDS-related deaths in 2018 100 000 [64 000–160 000]

17
GLOBAL AND REGIONAL DATA

Regional HIV and AIDS statistics and features  2018


Adults and children Adults and children Adult and child
living with HIV newly infected with HIV deaths due to AIDS

Eastern and southern Africa 20.6 million 800 000 310 000
[18.2 million–23.2 million] [620 000–1.0 million] [230 000–400 000]

Western and central Africa 5.0 million 280 000 160 000
[4.0 million–6.3 million] [180 000–420 000] [110 00–230 000]

Middle East and North Africa 240 000 20 000 8400


[160 000–390 000] [8500–40 000] [4800–14 000]

Asia and the Pacific 5.9 million 310 000 200 000
[5.1 million–7.1 million] [270 000–380 000] [160 000–290 000]

Latin America 1.9 million 100 000 35 000


[1.6 million–2.4 million] [79 000–130 000] [25 000–46 000]

Caribbean 340 000 16 000 6700


[290 000–390 000] [11 000–24 000] [5100–9100]

Eastern Europe and central Asia 1.7 million 150 000 38 000
[1.5 million–1.9 million] [140 000–160 000] [28 000–48 000]

Western and central Europe and 2.2 million 68 000 13 000


North America [1.9 million–2.4 million] [58 000–77 000] [9400–16 000]

TOTAL 37.9 million 1.7 million 770 000


[32.7 million–44.0 million] [1.4 million–2.3 million] [570 000–1.1 million]

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

Adults and children estimated to be living with HIV  1990–2018

Adults and children estimated to be living with HIV


Range of uncertainty

18
UNAIDS DATA 2019

Adults and children newly infected with HIV  1990–2018

Adults and children newly infected with HIV


Range of uncertainty

Adult and child deaths due to AIDS  1990–2018

Adult and child deaths due to AIDS


Range of uncertainty

19
350OF THE ARTICLE
TITLE

FIGURE 10.1 Antiretroviral therapy coverage and AIDS-related mortality among people living with HIV, eastern
EASTERN AND SOUTHERN AFRICA

and southern Africa

Lesotho
300

250

Eswatini
AIDS-related mortality (per 100 000)

Botswana

200

Mozambique

Zimbabwe
150

South Africa

Namibia

100 Zambia

South Sudan

Malawi

Kenya
Uganda
Mauritius Angola
50

United Republic of
Tanzania Rwanda

Eritrea
Madagascar Ethiopia
Comoros
0
0 10 20 30 40 50 60 70 80 90 100

People living with HIV receiving antiretroviral treatment (%)

Antiretroviral therapy coverage: 75% and above 55–74% 30–54% Less than 30%

Note: Size of bubble is proportional to size of of population of people living with HIV.

Source: UNAIDS 2019 estimates.

12 20
UNAIDS DATA 2019

EASTERN AND
SOUTHERN AFRICA

AT A GLANCE
The region Linkage to care Gender In addition to Innovations
has seen rapid is the biggest gap inequalities, a persistent lack in service
declines in new to achieving the gender-based of data on key delivery—and
HIV infections 90–90–90 targets, violence and populations, efforts to address
and AIDS-related but retention other harmful punitive laws structural factors
deaths in recent on treatment sociocultural that target those that impede access
years. However, of people living practices continue populations to services—are
progress is fragile, with HIV is to make adolescent are hampering needed for health
and it varies an increasing girls and young efforts to leave and HIV services
considerably challenge. women more no one behind. to reach more
within the region. vulnerable to HIV. men and boys.

While eastern and southern Africa as a whole has number lost to follow-up after initiating treatment.
made strong progress in the expansion of antiretroviral Investments are being made into strengthening health
therapy, coverage varies dramatically among countries, systems and delivering universal health coverage. In
from 9% in Madagascar to 92% in Namibia. The impact order to achieve success in the delivery of HIV services
of treatment on AIDS-related mortality has been strongest and broader health care to achieve the health-related
in the countries with higher coverage (Figure 10.1). Sustainable Development Goals, these efforts must be
Countries with comparatively low coverage—including well-coordinated.
Angola, Madagascar, Mauritius and the South
Sudan—need to accelerate their HIV testing and While the region has had some success in reducing
treatment programmes. new HIV infections among adolescent girls and young
women, large disparities still exist between young
There are challenges to retaining people living with women and men of the same age. HIV prevalence
HIV in treatment adherence, with an unacceptable remains extremely high among all key populations.

21
EASTERN AND SOUTHERN AFRICA

PART 1 | PART TITLE


STATE OF THE EPIDEMIC

FIGURE 10.2 Number of new HIV infections, An estimated 800 000 [620 000–1 000 000] people
eastern and southern Africa, 2000–2018 acquired HIV in eastern and southern Africa in 2018,
a decrease of 28% from the number of new HIV
Percentage
Number of new HIV infections

change in new infections in 2010 (Figure 10.2). Young women (aged


HIV infections 15–24 years) accounted for 26% of new HIV infections
since 2010 in the region, and an estimated one quarter (25%) of

-28%
new infections were among key populations and their
sexual partners (Figure 10.7). A number of countries
showed strong declines in new infections between
2010 and 2018, such as Comoros, Rwanda, South
Africa and Uganda, but new infections increased in
0 other countries, such as Angola, Madagascar and
2000

2010

2018
the South Sudan (Figure 10.5).
New HIV infections Source: UNAIDS 2019 estimates.
TITLE OF THE ARTICLE In 2018, there were 310 000 [230 000–400 000]
New HIV infections AIDS related deaths in the region, a 44% decrease
since 2010 (Figure 10.3). Five countries had
a decline in AIDS-related deaths of greater than
FIGURE 10.3 Number of AIDS-related deaths, 50% during the eight-year period: Kenya, Malawi,
eastern and southern Africa, 2000–2018 South Africa, Uganda and Zimbabwe. The region’s
1 400 000 incidence-prevalence ratio was 3.9% [3.0–5.1%]
Number of AIDS-related deaths

Percentage
change in AIDS- 1 200 000 in 2018, a considerable decline from 6.5% [5.0–8.5%]
related deaths
in 2010 (Figure 10.4).
since 2010 1 000 000

-44% 800 000

600 000
Ten of the 19 countries with data reported since 2014
had an HIV prevalence in excess of 40% among sex
400 000 workers, including an alarming 85% prevalence in
Uganda. The most recent data on HIV prevalence
200 000
among people who inject drugs exceeded 20% in half
0 of the six reporting countries. Among gay men and
2000

2010

2018

other men who have sex with men, HIV prevalence


was more than 30% in two of 12 countries with
AIDS-related deaths Source: UNAIDS 2019 estimates.
PART 1|
data since 2014, and more than 12% in another five
PART TITLE
countries. Among 14 countries that reported data,
AIDS-related deaths
median HIV prevalence among prisoners was 16.7%,
and among transgender people in Mauritius—the
FIGURE 10.4 Incidence-prevalence ratio, eastern only country in the region to report epidemiological
and southern Africa, 2000–2018 data on this key population—HIV prevalence was
28.4% in 2017.
2018 14
Incidence-prevalence
Incidence-prevalence ratio

12
ratio
10
3.9% 8
[3.0–5.1%] 6

4
3
2

Incidence-prevalence ratio Target value


Source: UNAIDS 2019 estimates.
Incidence–prevalence
Target
22
TITLE OF THE ARTICLE UNAIDS DATA 2019

FIGURE 10.5 Percentage change in new HIV infections, by country, eastern and southern Africa, 2010–2018

250

193
200

150
Per cent

100

50 35
6
0

-13 -13 -7 -7
-30 -29 -23
-50 -36 -34 -31 -30
-43 -40 -38 -38
-67 -61
-100

Source: UNAIDS 2019 estimates.

TITLE OF THE ARTICLE TITLE OF THE ARTICLE

FIGURE 10.6 HIV prevalence among key populations, FIGURE 10.7 Distribution of new HIV infections
eastern and southern Africa, 2014–2018 (aged 15–49 years), by population group, eastern
and southern Africa, 2018
100
People who
90 Sex workers
inject drugs
3% 8%
80
Gay men and
70 other men
60
Per cent

who have sex


50 with men
40.7 4%
40
28.4
30 Clients of sex
20 workers and sex
16.7 partners of other
10 13.7 15.2
key populations
Remaining
0 10%
population
75%
Sex workers (n = 19)
Gay men and other men who have sex with men (n = 12) Source: UNAIDS special analysis, 2019.
People who inject drugs (n = 6)
Transgender people (n = 1)
Prisoners (n = 14)

Source: Global AIDS Monitoring, 2014–2018.

18 23
TITLE OF THE
EASTERN ANDARTICLE
SOUTHERN AFRICA

TABLE 10.1 Estimated size of key populations, eastern and southern Africa, 2018

have sex with men as per cent

cent of adult population (15+)

Prisoners as per cent of adult


Gay men and other men who

Gay men and other men who

per cent of adult population


People who inject drugs as

Transgender people as per


Sex workers as per cent of
National adult population

of adult population (15+)

People who inject drugs


adult population (15+)

Transgender people
have sex with men

population (15+)
Sex workers

Prisoners
Country

(15+)

(15+)
Kenya 30 540 000
Lesotho 1 464 000
Madagascar 15 584 000
Malawi 10 782 000 15 000 0.14
Seychelles 75 000
South Africa 40 879 000
Uganda 23 286 000

National population size estimate Local population size estimate Insufficient data No data

The regions for which the local population size estimate refers are as follows:
Lesotho: Butha Buthe, Mafeteng, Maseru and Leribe.
South Africa: Cape Town Metro, Durban Metro and Johannesburg Metro.

Sources: Global AIDS Monitoring, 2018; United Nations, Department of Economic and Social Affairs, Population Division. World
population prospects: the 2017 revision. 2018 (custom data acquired via website).

Babongile Luhlongwane, a community health


agent, walks to deliver HIV information and services
to rural residents in Eshowe, South Africa.
Credit: Gred Lomas/Médecins Sans Frontières

3 24
should be allowed to attend school with children not living
Source: Population-based surveys, 2013–2017, countries with
with HIV
available data.
UNAIDS DATA 2019

THE CASCADE FROM HIV TESTING TO VIRAL


SUPPRESSION
FIGURE 10.8 HIV testing and treatment cascade, eastern and southern Africa, 2018

25
Number of people living with HIV (million)

20
Gap to reaching
the first 90: Gap to reaching
15 1.1 million the first and Gap to reaching
second 90s: the three 90s:
3.0 million 3.0 million
10
85%
[75–95%] 67% 58%
5 [52–78%] [50–66%]

People living with HIV People living with HIV People living with HIV
who know their status on treatment who are virally suppressed

Source: UNAIDS special analysis, 2019; see annex on methods for more details.
PART 1 | PART TITLE

FIGURE 10.9 Viral load suppression among adults (aged 15 years and older) living with HIV, by sex, eastern
and southern Africa, 2018
5
100
90
80
70
60
Per cent

50
40
30
20
10
0
Botswana Eswatini Lesotho Malawi Mauritius Namibia Rwanda South Uganda United
United Zambia
Africa Republic
Republic of
of Tanzania
Tanzania
Females Males
Source: UNAIDS special analysis, 2019.

Of the region’s estimated 20.6 million [18.2 million–23.2 additional 3 million people needed to access treatment
million] people living with HIV, the proportion who in order to reach the first and second 90s. An additional
knew their status increased from 77% [ 68–87%] in 2015 3 million people living with HIV needed to achieve viral
to 85% [75–95%] in 2018. An estimated 67% [52–78%] suppression to reach all three 90s (Figure 10.8). Linkage
of people living with HIV were on treatment (up from to care represents the single greatest challenge to
53% [41–61%] in 2015), while 58% [50–66%] were virally achieving the 90–90–90 targets, but efforts to achieve
suppressed (up from 43% [37–50%] in 2015). The gap viral suppression among people on treatment is growing
to reaching the first 90 stood at 1.1 million, while an in importance.

25
TITLE OF THE
EASTERN ANDARTICLE
SOUTHERN AFRICA

TABLE 10.2 90–90–90 country scorecard, eastern and southern Africa, 2018

First 90: percentage Second 90: Third 90: percentage Viral load suppression:
of people living with percentage of people of people living with percentage of people
HIV who know their living with HIV who HIV on treatment who living with HIV who
HIV status know their status and have suppressed viral are virally suppressed
who are on treatment loads

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)
Eastern and southern Africa 85 88 82 79 82 72 87 89 86 58 64 50
Angola 42 47 44 63 59 69
Botswana 91 >95 89 92 >95 80 >95 >95 >95 >95 93 69
Comoros 86 78 >95 91 80 >95 86 68
Eritrea 82 85 87 62 62 57 77 39
Eswatini 92 93 93 93 >95 85 94 95 94 81 86 75
Ethiopia 79 79 81 83 82 82
Kenya 89 94 88 77 80 67
Lesotho 86 89 82 71 73 66 93 95 91 57 61 49
Madagascar 11 21 7 84 75 >95
Malawi 90 94 89 87 92 76 89 92 89 69 79 61
Mauritius 22 19 23 >95 >95 >95 73 70 74 16 13 17
Mozambique 72 80 61 77 79 69
Namibia 91 95 87 >95 >95 88 95 >95 94 87 >95 72
Rwanda 94 >95 95 93 95 88 85 87 84 74 79 70
Seychelles 72 91
South Africa 90 93 88 68 71 63 87 89 85 54 58 47
South Sudan 24 28 22 66 67 62
Uganda 84 85 84 87 93 75 88 90 88 64 72 55
United Republic of Tanzania 78 82 73 92 >95 77 87 89 86 62 73 49
Zambia 87 88 87 89 95 79 75 75 75 59 63 52
Zimbabwe 90 94 86 >95 >95 >95

90–90–90: 90% and above 85–89% 70–84% 50–69% Less than 50%
Viral load suppression: 73% and above 65–72% 40–64% 25–39% Less than 25%

Source: UNAIDS special analysis, 2019.

Progress varies significantly among countries in the of status was below 25% in three countries, and in eight
region. Botswana, Eswatini and Namibia have achieved countries, no data were available on viral suppression.
the three 90s, while Rwanda has achieved the first Viral load suppression varies across the countries in the
two 90s and is closing in on the third (Table 10.2). region that have available data, and it was generally
Despite this, progress is alarmingly slow. Knowledge higher among women than among men (Figure 10.9).

1 26
UNAIDS DATA 2019

A COMBINATION APPROACH TO PREVENTION

Higher risk sex among adolescents and young the Gambela region of Ethiopia, Lesotho, the Nyanza
people—alongside laws requiring parental consent for province of Kenya and the United Republic of Tanzania
adolescents to access sexual and reproductive health (Figure 10.12). In Zimbabwe, fewer than one in four
services—continues to impact the region’s epidemic. adult men (aged 15–49 years) was circumcised.
Approximately eight in 10 sexually active adolescent In 2018, more than 4.1 million VMMCs were performed
boys and young men (and three in 10 sexually active in the region.
adolescent girls and young women) reported having
sex with a nonmarital, noncohabiting partner in the last An estimated 84 000 people in the region took pre-
year. In most countries, too few young people reported exposure prophylaxis (PrEP) at least once in 2018; 37%
using condoms during such higher risk sex, and in all of them resided in Kenya.1 Effective expansion of PrEP
countries but Lesotho, a lower proportion of young provision requires attracting people at high risk of HIV
women than young men reported doing so. A higher infection, supporting correct use and adherence, and
proportion of young men than young women reported strengthening other aspects of sexual and primary
having sex before the age of 15. health care.

The prevalence of male circumcision is high in the Very few data are available on the coverage of prevention
countries and provinces prioritized for voluntary services for members of key populations.
medical male circumcision (VMMC). Over 70% of
adult men (aged 15–49 years) are circumcised in PART 1 | PART TITLE

FIGURE 10.10 Condom use at last higher risk sex with a nonmarital, noncohabiting partner by young people
aged 15–24 years, 2012–2018

100
Target condom use
90
80
70
60
Per cent

50
40
30
20
10
0
ia
nz ic
an
Ta bl
of epu
R
d
i te
Un

Sexually active adolescent girls and young women reporting higher risk sex with a nonmarital,
noncohabiting partner in the last 12 months
Condom use of adolescent girls and young women at last higher risk sex with a nonmarital, noncohabiting partner
Sexually active adolescent boys and young men reporting higher risk sex with a nonmarital, noncohabiting partner in the last 12 months
Condom use ofactive
Sexually adolescent boys and
adolescent girls young men women
and young at last higher risk sex
reporting withrisk
higher a nonmarital, noncohabiting
sex with a non-marital, partner
non-cohabiting partner in
the last 12 months
Source: Population-based surveys, 2012–2018.
Condom use of adolescent girls and young women at last higher risk sex with a non-marital, non-cohabiting partner

Sexually active adolescent boys and young men reporting higher risk sex with a non-marital, non-cohabiting partner in the
last 12 months
Condom
1  This figure use include
does not of adolescent
peopleboys
who and youngPrEP
obtained menby
at private
last higher risk including
means, sex with athrough
non-marital,
onlinenon-cohabiting
purchasing. partner

27
EASTERN AND SOUTHERN AFRICA PART 1 | PART TITLE

FIGURE 10.11 Number of people taking PrEP at least once during 2018, eastern and southern Africa, 2018
Number of people

Source: 2019 Global AIDS Monitoring; and PEPFAR Monitoring, Evaluation, and Reporting Database. In: amfAR.org [Internet]. amfAR;
c2019 (https://mer.amfar.org/?_ga=2.96796184.623148132.1561384951-1316132509.1561384951, accessed 20 June 2019).
PART 1 | PART TITLE

FIGURE 10.12 Prevalence of male circumcision (aged 15–49 years), by country (province), eastern and
southern Africa, 2013–2017

100
Gambela

90
Nyanza

80

70

60
Per cent

50

40

30

20

10

Note: Surveys included are: Kenya (2014), Nyanza (Kenya) (2014), Ethiopia (2016), Gambela (Ethiopia) (2016), the United
Republic of Tanzania (2017), Lesotho (2014), Mozambique (2015), South Africa (2017), Uganda (2016), Namibia (2017),
Eswatini (2016), Rwanda (2014), Zambia (2016), Botswana (2013), Malawi (2016) and Zimbabwe (2016).

Source: Population-based surveys, 2013–2017.

28 19
TITLE OF THE ARTICLE UNAIDS DATA 2019

FIGURE 10.13 Proportion of young people reporting sex before the age of 15 years and corresponding
parental consent policies regarding young people’s access to sexual and reproductive health services,
eastern and southern Africa, 2012–2016

50
45
40
34
35
Per cent

30
25 24
25 23 22
21
19
20 17 16
15 14
15 12 12 13 12 12 13
11 10 9
10 6 7
5 5 5 5 6
5 1
0
Mozambique

Rwanda
Kenya

Uganda

Malawi

Lesotho

Zambia

Ethiopia

Angola
Namibia

Zimbabwe

United Republic of Tanzania


South Africa

Comoros

No parental consent required Yes, for Yes , for adolescents younger than Data not
adolescents 16 or 18 years available
younger than 14 on
years parental
consent

Sex before the age of 15 [females]


Sex before the age of 15 [males]

Source: Population-based surveys, 2012–2016.


TITLE OF THE ARTICLE

FIGURE 10.14 Percentage of key populations whoŘada1 Řada2


reported receiving at least two prevention services in the
past three months, eastern and southern Africa, 2016–2018

100
90 Sex workers
80
Gay men and other men who have sex with men
70
People who inject drugs
Per cent

60
Transgender people
50
40
30
20 Notes: Possible prevention services received among sex workers,
10 gay men and other men who have sex with men and transgender
people: condoms and lubricant, counselling on condom use and
0
safe sex, and testing for sexually transmitted infections. Possible
South Sudan

United Republic of Tanzania


Seychelles
Malawi

Zimbabwe
Uganda

prevention services received among people who inject drugs:


condoms and lubricant, counselling on condom use and safe sex,
and clean needles or syringes.

Data for female sex workers in Malawi and the United Republic of
Tanzania and for gay men and other men who have sex with men in
Malawi and Zimbabwe come from programmes (which tend to show
higher values) and not from a survey.

Source: Global AIDS Monitoring, 2016–2018.

16 Female sex workers 29

Gay men and other men who have sex with


EASTERN AND SOUTHERN AFRICA

TITLE OF THE ARTICLE


ELIMINATING MOTHER-TO-CHILD TRANSMISSION

A total of 92% [69–>95%] of pregnant women living FIGURE 10.15 Cascade of services for preventing
with HIV received antiretroviral medicines to prevent vertical transmission, numbers of new HIV infections
mother-to-child transmission of HIV and to protect their and transmission rate, eastern and southern
own health in 2018 (Figure 10.15). This is compared Africa, 2018
to 49% [37–59%] in 2010. The rate of mother-to-child
transmission decreased from 18% [15–25%] in 2010 to 1 000 000 92%
900 000 [69– >95%]
9% [8–13%] in 2018. Coverage of early infant diagnosis
800 000
was 68% [56–91%] in 2018. Progress could be bolstered 68%
700 000 [56–91%]

Number
by the further expansion of point-of-care early infant
600 000
diagnostics.
500 000
400 000
300 000 Transmission
200 000 rate: 9%
[8–13%]
100 000
0

eight weeks of age

New child infections


Births to women

prevent vertical transmission


living with HIV

Infants tested by
Women receiving
antiretrovirals to
Any birth to women living with HIV
Any birth to women living with HIV
Children newly infected with HIV
Children newly infected with HIV

Source: UNAIDS 2019 estimates; 2019 Global AIDS Monitoring.

WOMEN LIVING WITH HIV HAVING THEIR SAY ON DUAL ELIMINATION

Community engagement is critical to ensuring that efforts to eliminate mother-to-child transmission


of HIV and syphilis are achieved in a manner that protects and respects the human rights of women,
particularly women living with HIV and/or syphilis. The International Community of Women Living with
HIV and AIDS Eastern Africa (ICWEA) has been active in validation efforts in Uganda.

ICWEA held focus group discussions with 264 women living with HIV from six regions of Uganda to
assess whether services to prevent vertical transmission were implemented in a manner consistent with
international, regional and national human rights standards. The assessment determined that Uganda
has progressive laws and policies that have facilitated reductions of mother-to-child transmission in the
country (1). The Patients’ Charter, the Constitution of the Republic of Uganda and the HIV Prevention
and AIDS Control Act guarantee equality and nondiscrimination in health-care settings for all persons.

The ICWEA assessment also expressed serious concern about laws that criminalize HIV and syphilis
transmission, and about health-care guidelines that aggressively promote HIV testing and disclosure
of HIV status. Women living with HIV who participated in focus group discussions said that health
workers do not always seek informed consent from pregnant women when offering an HIV test, nor
do they always communicate the option to refuse such a test. Participants also suggested that some
women living with HIV are taking contraceptives against their will (1).

30
UNAIDS DATA 2019

CONFRONTING STIGMA AND DISCRIMINATION

Many people across the region still lack basic FIGURE 10.16 Percentage of men and women aged
knowledge about HIV. Levels of stigma towards 15–49 years with discriminatory attitudes towards
people living with HIV remain high: more than half people living with HIV, eastern and southern Africa,
of people surveyed in Ethiopia said they would 2013–2017
avoid buying vegetables from a vendor living with
HIV, and 42% believed that children living with 60

HIV should not be allowed to attend school with 50


other children. In other countries, such stigmatizing
attitudes were reported by between 6% and 31% 40

Per cent
of survey participants (Figure 10.16). 30

20
Some progress has been made to strike down
laws that criminalize and discriminate against 10
key populations. In June 2019, Botswana joined
0
the growing list of countries globally that have

Angola

Rwanda
Uganda

Mozambique

Zimbabwe

Malawi

Kenya

Sudan
Zambia

Lesotho
Ethiopia

South Africa
Namibia
decriminalized same-sex sexual relations (2).
However, there also have been setbacks, with
Kenya recently deciding to uphold such a law (3).

Unacceptable levels of intimate partner violence People who would not buy vegetables from a shopkeeper
Percentage of people who would not buy vegetables from a
persist. According to surveys, physical and/or living with HIV
shopkeeper living with HIV
sexual violence by an intimate partner in the past People who think children living with HIV should not be
12 months was reported by around 30% of women allowed to attend
Percentage school
of people whowith children
think not
children living
living with
with HIV
HIV
should be allowed to attend school with children not living
in South Africa, Uganda and the United Republic of Source: Population-based surveys, 2013–2017, countries with
with HIV
Tanzania; by more than 25% in Angola, Kenya and available data.
Zambia;
TITLE OFand
THEby ARTICLE
20% or more in Ethiopia, Malawi,
Namibia, Rwanda and Zimbabwe.

FIGURE 10.17 Proportion of women aged 15–49 years who reported ever experiencing physical and/or
sexual violence committed by partner/husband or controlling behaviour, 2012–2016
100
90
FIGURE 10.8 HIV testing and treatment cascade, eastern and sou
80
70
25
Number of people living with HIV (million)

60
Per cent

50
20
40
Gap to reaching
30 the first 90: G
20 15 1.1 million t
s
10 3
0 10
85%
ia
nz ic

[75–95%]
an
Ta bl
of epu

5
R
d
i te
Un

Women reporting husband/partner displays controlling behaviour 0


Women reporting ever experiencing physical violence committed by husband/partner People living with HIV People living with
who know their status
Women reporting ever experiencing physical or sexual violence committed by husband/partner on treatment

Women reporting physical or sexual violence committed by male intimate partner in preceding 12 months
Source:
Women reporting husband/partner displays controlling UNAIDS special analysis, 2019; see annex on methods for more details.
behaviours
Source: Population-based surveys, 2012–2016.
Women reporting ever experiencing physical violence committed by husband/partner
Women reporting ever experiencing physical or sexual violence committed by husband/partner 31

Women reporting physical or sexual violence committed by male intimate parnter in preceding 12 months
EASTERN AND SOUTHERN AFRICA

INVESTING TO END AN EPIDEMIC

Domestic and international resources for HIV responses South Africa increased its domestic public spending for
in the region increased steadily from 2010 to 2018, HIV by about US$ 650 million between 2010 and 2018,
growing by 34% and 31%, respectively (in constant 2016 and now 78% of the total HIV resources in the country
US dollars).2 Available resources in 2018 approach the are domestic. Other countries in the region with a high
2020 Fast-Track Targets, with 59% of these resources burden of disease have also increased their domestic
still provided by donors. The Government of the resources since 2010: they have increased by more than
United States increased its bilateral funding by 59% 70% in Zambia and Zimbabwe and by more than 30%
and the Global Fund to Fight AIDS, Tuberculosis and in Kenya and Malawi.
Malaria (the Global Fund) increased its funding by
12% between 2010 and 2018, while financial resources Excluding South Africa, countries in eastern and
provided through all other international donor channels southern Africa had a 10% annual decline in resource
decreased by 18%. availability in 2018, mainly due to domestic resources
decreasing by 27% and all international resources
Compared to the previous year, the total amount decreasing by 4%. These countries finance only 20%
of resources for HIV responses in the region in 2018 of their responses domestically, and they will need to
decreased by 7% (after adjusting for inflation): domestic mobilize almost US$ 800 million in additional resources
funds decreased by 9%, United States bilateral funding by 2020 to achieve their resource needs estimates,
decreased by 2%, Global Fund funding decreased by while also improving their efficiency in using both
29% and funding from all other international channels existing and future resources.
decreased by 10%.3
PART 1 | PART TITLE

FIGURE 10.18 HIV resource availability, by source, eastern and southern Africa, 2010–2018, and projected
resource needs by 2020
US$ (million)

Domestic (public and private)


United States (bilateral)
Global Fund
Other international
Resource needs (Fast-Track)

Source: UNAIDS 2019 resource


2010 2011 2012 2013 2014 2015 2016 2017 2018 2020 availability and needs estimates.

Domestic (public and private)


United States (Bilateral)
Global Fund
Other international
Resource Needs fast-track
2 Details on the revised UNAIDS estimates for resource availability in low- and middle-income countries can be found in the Investing to
End an Epidemic chapter.
3 The Global Fund disbursements to countries decreased by 20% in 2018 because most funding grants ended in 2017, hence the
changes in the level of disbursements.

32
UNAIDS DATA 2019

REFERENCES
1. Certifying Uganda on the path towards elimination of mother-to-child transmission of HIV. Perspectives of women living with HIV
on human rights, gender equality and engagement of civil society in the validation process. International Community of Women
Living with HIV and AIDS Eastern Africa; 2018.
2. Burke J. Botswana judges rule laws criminalising gay sex are unconstitutional. The Guardian. 11 June 2019
(https://www.theguardian.com/world/2019/jun/11/botswana-high-court-decriminalises-gay-sex, accessed 22 June 2019).
3. UNAIDS deeply regrets the decision of the High Court of Kenya to maintain laws that criminalize and discriminate against
LGBT people. IN: UNAIDS [Internet]. 24 May 2019. Geneva: UNAIDS; c2019 (https://www.unaids.org/en/resources/presscentre/
pressreleaseandstatementarchive/2019/may/20190524_Kenya_laws_against_lgbt, accessed 7 July 2019).

33
Country tables

ANGOLA COUNTRY DATA

ANGOLA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
26 000 27 000 28 000
New HIV infections (all ages)
[21 000–32 000] [21 000–34 000] [21 000–36 000]
6800 6500 7000
New HIV infections (0–14)
[5400–8600] [4800–8400] [5000–9500]
14 000 14 000 14 000
New HIV infections (women, 15+)
[11 000–16 000] [11 000–18 000] [11 000–19 000]
6200 6500 6700
New HIV infections (men, 15+)
[4800–8100] [4800–8400] [4700–8900]

HIV incidence per 1000 population 1.21 [0.96–1.47] 1.06 [0.83–1.32] 1.01 [0.75–1.29]

AIDS-related deaths
10 000 10 000 14 000
AIDS-related deaths (all ages)
[7300–13 000] [7200–13 000] [9500–18 000]
4100 4400 4900
AIDS-related deaths (0–14)
[3200–5200] [3400–5600] [3700–6400]
4200 3500 6100
AIDS-related deaths (women, 15+)
[2900–5800] [2300–4900] [4100–8300]
1800 2200 2500
AIDS-related deaths (men, 15+)
[1200–2700] [1500–3100] [1700–3500]

People living with HIV


220 000 290 000 330 000
People living with HIV (all ages)
[180 000–250 000] [250 000–340 000] [290 000–390 000]
28 000 34 000 38 000
People living with HIV (0–14)
[23 000–34 000] [27 000–42 000] [30 000–47 000]
130 000 180 000 200 000
People living with HIV (women, 15+)
[110 000–150 000] [150 000–210 000] [180 000–240 000]
59 000 80 000 92 000
People living with HIV (men, 15+)
[50 000–72 000] [68 000–96 000] [78 000–110 000]
HIV prevalence (15–49) 1.7 [1.5–2] 1.9 [1.7–2.2] 2 [1.7–2.3]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2016
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting towards people living with HIV
... 34.6
adults

Laws penalizing same-sex sexual Percentage of people living with HIV denied
Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in
never existed the last 12 months

Drug use or possession for personal use is an


... Percentage of people living with HIV who
offence
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people Both criminalized and prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
Yes VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2016
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 25.9
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 ... $3 292 607 $14 632 684 $2 195 073 ... $20 120 364

34
EPIDEMIC TRANSITION METRICS

40 000 20 000 25% 40 000


Number of people

Number of people

Number of people
30 000 20%
15 000 30 000
15%

Percent
20 000 10 000 20 000
10%
10 000 5 000 10 000
5%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = 6% related deaths = 33% prevalence = 8%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 18 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [9000
who have inject drugs people cases among people living with HIV (2017)
–30 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 12.8%
preventive therapy (2017)
HIV prevalence 8.0% 2.0% ... ... 15.9%
Cervical cancer screening of women living
Know their HIV status 26.8% 44.8% ... ... ...
with HIV
Antiretroviral therapy coverage 42.0% ... ... ... 100%
People coinfected with HIV and hepatitis B
Condom use 71.7% 59.1% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $567 162 $303 598 $0
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


350 000 100% people aged 15–24 years (2015)

300 000 ― Women 32.5%


Number of people living with HIV

75% ― Men 31.6%


250 000
Gap to Condom use at last sex with a non-marital,
200 000 reaching the
first 90:
Gap to 50% non-cohabiting partner (2016)
150 000 reaching the
160 000
first and ― Women 32.1%
100 000 second 90: 25% ― Men 63.3%
181 000
50 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 29.8%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised Not
All ages 42% [36–50%] 27% [23–31%] ...% [...–...%] (2016) applicable
88 700
Voluntary medical male circumcisions Not
Children (0–14) 13% [10–16%] 13% [10–16%] ...% [...–...%] performed according to national standards applicable
4800
People who received PrEP at least once
...
Women (15+) 47% [40–55%] 27% [24–32%] ...% [...–...%] during the reporting period
56 100
Harm reduction
Men (15+) 44% [37–52%] 30% [26–36%] ...% [...–...%]
27 800 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 18% 38% therapy
accessing antiretroviral medicines [14–23%] [29–48%]
― Naloxone available (2019) No
2.4% 1.4%
Early infant diagnosis
[1.9–3.1%] [1.1–1.8%] ― Safe injection rooms available (2019) No

35
BOTSWANA COUNTRY DATA

BOTSWANA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
13 000 10 000 8500
New HIV infections (all ages)
[12 000–14 000] [9000–11 000] [7000–10 000]
2100 1100 <500
New HIV infections (0–14)
[1400–2600] [530–1500] [<500–630]
6200 5000 4500
New HIV infections (women, 15+)
[5500–6700] [4300–5600] [3700–5400]
5100 4200 3700
New HIV infections (men, 15+)
[4500–5700] [3600–4800] [3000–4400]

HIV incidence per 1000 population 7.98 [7.28–8.66] 5.61 [4.88–6.17] 4.36 [3.6–5.19]

AIDS-related deaths
7300 5000 4800
AIDS-related deaths (all ages)
[6500–8000] [4300–5800] [4100–5700]
1500 710 520
AIDS-related deaths (0–14)
[1100–1800] [<500–990] [<500–780]
3100 2100 2100
AIDS-related deaths (women, 15+)
[2700–3500] [1800–2500] [1800–2600]
2600 2200 2200
AIDS-related deaths (men, 15+)
[2300–2900] [1800–2500] [1900–2600]

People living with HIV


340 000 360 000 370 000
People living with HIV (all ages)
[300 000–360 000] [320 000–390 000] [330 000–400 000]
25 000 19 000 14 000
People living with HIV (0–14)
[22 000–29 000] [15 000–22 000] [10 000–17 000]
180 000 190 000 200 000
People living with HIV (women, 15+)
[160 000–190 000] [170 000–210 000] [180 000–220 000]
140 000 150 000 150 000
People living with HIV (men, 15+)
[120 000–150 000] [130 000–160 000] [140 000–170 000]
HIV prevalence (15–49) 23.2 [20.9–24.8] 21.6 [18.9–23.1] 20.3 [17.3–21.8]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Laws penalizing same-sex sexual Percentage of people living with HIV denied 2013
Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in
never existed the last 12 months 3

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are 2013
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people 2
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 16 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


Yes
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $0 $100 590 814 $47 684 258 $10 716 702 $0 $158 991 773

36
EPIDEMIC TRANSITION METRICS

35 000 25 000 12% 30 000


30 000 10%
Number of people

Number of people

Number of people
20 000
25 000
8% 20 000
15 000

Percent
20 000
6%
15 000 10 000
10 000 4% 10 000
5 000 5 000 2%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


Incidence:
HIV infections = -36% related deaths = -33% prevalence = 2% mortality ratio = 1.2
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 3300
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [2100
who have inject drugs people cases among people living with HIV (2017)
–4700]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 42.2% 14.8% ... ... ...
Women who tested positive for HIV among
Know their HIV status ... ... ... ... those screened for cervical cancer 29.9%
(programme data) (2018)
Antiretroviral therapy coverage 87.6% 73.5% ... ... ...
People coinfected with HIV and hepatitis B
Condom use 75.7% 77.5% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
3.7%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


340 000 100% people aged 15–24 years (2016)

330 000 ― Women 47.4%


Number of people living with HIV

75% ― Men 47.1%


320 000

310 000 Condom use at last sex with a non-marital,


50% non-cohabiting partner
300 000
― Women ...
290 000
25% ― Men ...
280 000
Women aged 15–49 years who have their
270 000 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 91% [82– >95%] 83% [75–90%] 81% [73–88%]
307 000 Voluntary medical male circumcisions
performed according to national standards 24 207
Children (0–14) 44% [32–53%] 38% [28–46%] 34% [25–42%]
(2018)
5400
People who received PrEP at least once
38
Women (15+) >95% [86– >95%] >95% [86– >95%] 93% [84– >95%] during the reporting period (2018)
194 000
Harm reduction
Men (15+) 89% [80– >95%] 71% [64–78%] 69% [62–75%]
108 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 68% >95% therapy
accessing antiretroviral medicines [57–77%] [77– >95%]
― Naloxone available (2019) No
42.4% 76.5%
Early infant diagnosis
[37.4–50.5%] [67.7– >95%] ― Safe injection rooms available (2019) No

37
COMOROS COUNTRY DATA

COMOROS

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
<100 <100 <100
New HIV infections (all ages)
[<100– <100] [<100– <100] [<100– <100]
... ... ...
New HIV infections (0–14)
[...–...] [...–...] [...–...]
<100 <100 <100
New HIV infections (women, 15+)
[<100– <100] [<100– <100] [<100– <100]
<100 <100 <100
New HIV infections (men, 15+)
[<100– <100] [<100– <100] [<100– <100]

HIV incidence per 1000 population 0.01 [<0.01–0.03] 0.01 [<0.01–0.02] <0.01 [<0.01–0.01]

AIDS-related deaths
<100 <100 <100
AIDS-related deaths (all ages)
[<100– <100] [<100– <100] [<100– <100]
... ... ...
AIDS-related deaths (0–14)
[...–...] [...–...] [...–...]
<100 <100 <100
AIDS-related deaths (women, 15+)
[<100– <100] [<100– <100] [<100– <100]
<100 <100 <100
AIDS-related deaths (men, 15+)
[<100– <100] [<100– <100] [<100– <100]

People living with HIV


<200 <200 <200
People living with HIV (all ages)
[<100– <500] [<100– <500] [<100– <500]
... ... ...
People living with HIV (0–14)
[...–...] [...–...] [...–...]
<100 <100 <100
People living with HIV (women, 15+)
[<100– <100] [<100– <100] [<100– <100]
<100 <100 <100
People living with HIV (men, 15+)
[<100– <200] [<100– <200] [<100– <200]
HIV prevalence (15–49) <0.1 [<0.1– <0.1] <0.1 [<0.1– <0.1] <0.1 [<0.1– <0.1]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
No Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in
the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV
No Proportion of ever-married or partnered
testing
women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2018 ... $160 037 ... $1 062 108 $20 932 $1 243 077

38
EPIDEMIC TRANSITION METRICS

30 10 4% 15
25
Number of people

Number of people

Number of people
8 3%
20 10
6

Percent
15 2%
4
10 5
2 1%
5
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -67% related deaths = 0% prevalence =
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and
other men People who Transgender
Estimated number of incident tuberculosis 9
Sex workers Prisoners cases among people living with HIV (2017) [6–13]
who have inject drugs people
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 10%
preventive therapy (2017)
HIV prevalence 0.3% 0.0% 1.8% ... ...
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 26.0% 56.2% 43.8% ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $0 $0 $0
Adults aged 15+ years with unsuppressed
<0.1%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


120 100% people aged 15–24 years
Gap to ― Women ...
100
Number of people living with HIV

reaching the Gap to


first 90: reaching the 75% ― Men ...
Gap to
80 0 first and reaching all
second 90: three 90s: Condom use at last sex with a non-marital,
60 0 10 50% non-cohabiting partner

40 ― Women ...
25% ― Men ...
20
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed
Not
Men aged 15–49 years who are circumcised
All ages 86% [43– >95%] 79% [39– >95%] 68% [34– >95%] applicable
100
Voluntary medical male circumcisions Not
Children (0–14) ...% [...–...%] ...% [...–...%] ...% [...–...%] performed according to national standards applicable
...
People who received PrEP at least once
...
Women (15+) 78% [42– >95%] 63% [33– >95%] ...% [...–...%] during the reporting period
30
Harm reduction
Men (15+) >95% [50– >95%] >95% [50– >95%] ...% [...–...%]
60 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV ...% ...% therapy
accessing antiretroviral medicines [...–...%] [...–...%]
― Naloxone available (2019) No
...% ...%
Early infant diagnosis
[...–...%] [...–...%] ― Safe injection rooms available (2019) No

39
ERITREA COUNTRY DATA

ERITREA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
810 640 580
New HIV infections (all ages)
[510–1200] [<500–1100] [<500–1000]
<500 <200 <200
New HIV infections (0–14)
[<200– <500] [<100– <500] [<100– <500]
<500 <500 <500
New HIV infections (women, 15+)
[<500–540] [<200–530] [<200–500]
<500 <200 <200
New HIV infections (men, 15+)
[<200– <500] [<200– <500] [<100– <500]

HIV incidence per 1000 population 0.28 [0.18–0.42] 0.18 [0.1–0.32] 0.15 [0.08–0.28]

AIDS-related deaths
620 <500 <500
AIDS-related deaths (all ages)
[<500–980] [<500–830] [<500–890]
<200 <200 <200
AIDS-related deaths (0–14)
[<200– <500] [<100– <200] [<100– <200]
<500 <500 <500
AIDS-related deaths (women, 15+)
[<200– <500] [<200– <500] [<200– <500]
<200 <200 <200
AIDS-related deaths (men, 15+)
[<200– <500] [<100– <500] [<100– <500]

People living with HIV


17 000 18 000 18 000
People living with HIV (all ages)
[13 000–22 000] [13 000–23 000] [13 000–24 000]
1800 1500 1300
People living with HIV (0–14)
[1300–2400] [1000–2200] [930–2000]
9300 9800 9800
People living with HIV (women, 15+)
[7000–12 000] [7500–13 000] [7400–13 000]
6000 6300 6400
People living with HIV (men, 15+)
[4500–7900] [4800–8500] [4800–8700]
HIV prevalence (15–49) 0.9 [0.7–1.2] 0.8 [0.6–1.1] 0.7 [0.5–0.9]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
... Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting towards people living with HIV
...
adults

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months

Drug use or possession for personal use is an


...
offence Percentage of people living with HIV who
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people ...

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV
... Proportion of ever-married or partnered
testing
women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
... intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


...
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2018 ... ... ... $4 631 024 ... $4 631 024

40
EPIDEMIC TRANSITION METRICS

2 000 2 000 12% 2 000


10%
Number of people

Number of people

Number of people
1 500 1 500 1 500
8%

Percent
1 000 1 000 6% 1 000
4%
500 500 500
2%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -29% related deaths = -21% prevalence = 3%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and
other men People who Transgender
Estimated number of incident tuberculosis 150
Sex workers Prisoners cases among people living with HIV (2017) [95–210]
who have inject drugs people
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 37.7%
preventive therapy (2017)
HIV prevalence 10.4% ... ... ... 1.3%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 94.5% ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


18 000 100% people aged 15–24 years
16 000 ― Women ...
Gap to
Number of people living with HIV

14 000 reaching the 75% ― Men ...


12 000 first 90:
1400 Gap to
reaching the Condom use at last sex with a non-marital,
10 000 Gap to
first and reaching all 50% non-cohabiting partner
8 000 second 90: three 90s:
6 000 5400 ― Women ...
6000
4 000 25% ― Men ...
2 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed
Not
Men aged 15–49 years who are circumcised
All ages 82% [61– >95%] 51% [38–68%] 39% [29–53%] applicable
8900
Voluntary medical male circumcisions Not
Children (0–14) 37% [26–55%] 37% [26–55%] ...% [...–...%] performed according to national standards applicable
500
People who received PrEP at least once
...
Women (15+) 85% [64– >95%] 53% [40–72%] ...% [...–...%] during the reporting period
5200
Harm reduction
Men (15+) 87% [64– >95%] 50% [37–67%] ...% [...–...%]
3200 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 21% 48% therapy
accessing antiretroviral medicines [15–29%] [34–69%]
― Naloxone available (2019) ...
...% 20.2%
Early infant diagnosis
[...–...%] [14.1–28.6%] ― Safe injection rooms available (2019) ...

41
ESWATINI COUNTRY DATA

ESWATINI

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
11 000 9800 7800
New HIV infections (all ages)
[11 000–12 000] [9000–11 000] [6900–8900]
1300 850 850
New HIV infections (0–14)
[1000–1700] [710–1200] [510–1200]
5900 5300 4100
New HIV infections (women, 15+)
[5400–6400] [4800–5900] [3600–4700]
4000 3700 2800
New HIV infections (men, 15+)
[3700–4500] [3400–4200] [2500–3300]

HIV incidence per 1000 population 14.41 [13.56–15.38] 11.48 [10.62–12.69] 8.62 [7.64–9.97]

AIDS-related deaths
3800 2600 2400
AIDS-related deaths (all ages)
[3400–4200] [2300–3000] [2000–2900]
1100 <500 <500
AIDS-related deaths (0–14)
[900–1400] [<500–720] [<500– <500]
1500 1300 1300
AIDS-related deaths (women, 15+)
[1300–1700] [1100–1500] [1000–1500]
1200 890 830
AIDS-related deaths (men, 15+)
[1000–1300] [770–1000] [670–990]

People living with HIV


160 000 190 000 210 000
People living with HIV (all ages)
[150 000–170 000] [180 000–210 000] [190 000–220 000]
13 000 12 000 11 000
People living with HIV (0–14)
[11 000–14 000] [11 000–14 000] [9400–13 000]
93 000 110 000 120 000
People living with HIV (women, 15+)
[86 000–100 000] [110 000–120 000] [110 000–130 000]
54 000 67 000 72 000
People living with HIV (men, 15+)
[50 000–60 000] [62 000–74 000] [66 000–80 000]
HIV prevalence (15–49) 27.4 [25.2–29.3] 28.1 [26–29.9] 27.3 [25.1–29]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non- No, but prosecutions exist based
Percentage of women and men aged 15–49 2010 2014
disclosure of or exposure to HIV transmission on general criminal laws
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
12.5 5.7
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
Yes intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2013 ... $33 155 127 ... ... $63 776 395 $96 931 522

42
EPIDEMIC TRANSITION METRICS

20 000 10 000 15% 15 000


Number of people

Number of people

Number of people
15 000 8 000
10% 10 000
6 000

Percent
10 000
4 000
5% 5 000
5 000 2 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


Incidence:
HIV infections = -31% related deaths = -35% prevalence = 4% mortality ratio = 2.0
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 2900
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [1900
who have inject drugs people cases among people living with HIV (2017)
–4200]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 1%
preventive therapy (2017)
HIV prevalence 60.5% 12.6% ... ... 34.9%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 82.9% 57.6% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
5%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


195 000 100% people aged 15–24 years (2014)

190 000 ― Women 49.1%


Number of people living with HIV

185 000 75% ― Men 50.9%


180 000
Condom use at last sex with a non-marital,
175 000 50% non-cohabiting partner
170 000 ― Women ...
165 000 25% ― Men ...
160 000
Women aged 15–49 years who have their
155 000 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 92% [86– >95%] 86% [80–94%] 81% [76–89%]
177 000 Voluntary medical male circumcisions
performed according to national standards 14 316
Children (0–14) 78% [65–91%] 76% [63–88%] 67% [56–78%]
(2018)
8600
People who received PrEP at least once
...
Women (15+) 93% [87– >95%] 91% [85– >95%] 86% [80–93%] during the reporting period
111 000
Harm reduction
Men (15+) 93% [86– >95%] 79% [73–87%] 75% [69–82%]
57 100 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 73% 79% therapy
accessing antiretroviral medicines [61–81%] [66–89%]
― Naloxone available (2019) No
43.0% 78.0%
Early infant diagnosis
[38.5–51.3%] [69.6–93.9%] ― Safe injection rooms available (2019) No

43
ETHIOPIA COUNTRY DATA

ETHIOPIA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
29 000 24 000 23 000
New HIV infections (all ages)
[18 000–52 000] [14 000–42 000] [14 000–40 000]
6200 3300 2700
New HIV infections (0–14)
[3600–13 000] [1900–6900] [1600–5600]
14 000 13 000 12 000
New HIV infections (women, 15+)
[8600–26 000] [7500–22 000] [7300–22 000]
8600 7800 7600
New HIV infections (men, 15+)
[5100–15 000] [4600–14 000] [4500–13 000]

HIV incidence per 1000 population 0.39 [0.24–0.69] 0.27 [0.17–0.49] 0.24 [0.14–0.43]

AIDS-related deaths
20 000 13 000 11 000
AIDS-related deaths (all ages)
[12 000–35 000] [7800–22 000] [6800–19 000]
5400 2400 1800
AIDS-related deaths (0–14)
[2600–11 000] [1200–5000] [870–3800]
8600 6400 5500
AIDS-related deaths (women, 15+)
[5100–15 000] [3800–11 000] [3300–9900]
5900 3900 3700
AIDS-related deaths (men, 15+)
[3900–10 000] [2600–6700] [2500–6300]

People living with HIV


630 000 670 000 690 000
People living with HIV (all ages)
[480 000–830 000] [510 000–870 000] [530 000–900 000]
58 000 42 000 36 000
People living with HIV (0–14)
[37 000–87 000] [27 000–64 000] [23 000–55 000]
360 000 390 000 410 000
People living with HIV (women, 15+)
[280 000–470 000] [300 000–510 000] [320 000–540 000]
210 000 230 000 240 000
People living with HIV (men, 15+)
[160 000–270 000] [180 000–300 000] [180 000–310 000]
HIV prevalence (15–49) 1.3 [1–1.8] 1.1 [0.8–1.5] 1 [0.7–1.4]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2011 2016
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
59.9 58.5
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, penalty not specified health services because of their HIV status in
the last 12 months

Drug use or possession for personal use is an


...
offence Percentage of people living with HIV who
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people ...

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2016
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 19.8
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2016 ... $54 369 431 $200 243 640 $59 670 093 $37 300 707 $351 583 871

44
EPIDEMIC TRANSITION METRICS

100 000 120 000 15% 80 000


Number of people

100 000

Number of people
80 000

Number of people
60 000
80 000 10%
60 000

Percent
60 000 40 000
40 000
40 000 5%
20 000 20 000
20 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -23% related deaths = -45% prevalence = 3%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 12 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [8600
who have inject drugs people cases among people living with HIV (2017)
–17 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 45.5%
preventive therapy (2017)
HIV prevalence 24.3% ... ... ... ...
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use ... ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2016) $35 492 $0 $0
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


700 000 100% people aged 15–24 years (2016)

600 000 ― Women 24.3%


Number of people living with HIV

Gap to
reaching the 75% ― Men 39.1%
500 000 Gap to
first 90:
reaching the
400 000 77 700
first and Condom use at last sex with a non-marital,
second 90: 50% non-cohabiting partner (2016)
300 000 109 000
― Women 21.3%
200 000
25% ― Men 54%
100 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 61.4%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
91%
All ages 79% [60– >95%] 65% [50–85%] ...% [...–...%] (2016)
450 000 Voluntary medical male circumcisions
performed according to national standards 23 009
Children (0–14) 59% [38–90%] 59% [38–90%] ...% [...–...%]
(2018)
21 500
People who received PrEP at least once
...
Women (15+) 79% [61– >95%] 65% [50–85%] ...% [...–...%] during the reporting period
269 000
Harm reduction
Men (15+) 81% [62– >95%] 66% [51–86%] ...% [...–...%]
160 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 28% 92% therapy
accessing antiretroviral medicines [19–38%] [63– >95%]
― Naloxone available (2019) No
52.5% 60.8%
Early infant diagnosis
[37.7–76.7%] [43.7–88.8%] ― Safe injection rooms available (2019) No

45
KENYA COUNTRY DATA

KENYA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
66 000 51 000 46 000
New HIV infections (all ages)
[38 000–110 000] [30 000–88 000] [27 000–78 000]
18 000 9100 7600
New HIV infections (0–14)
[10 000–30 000] [5200–15 000] [4400–13 000]
30 000 26 000 24 000
New HIV infections (women, 15+)
[17 000–52 000] [15 000–46 000] [14 000–41 000]
18 000 16 000 14 000
New HIV infections (men, 15+)
[10 000–33 000] [9000–29 000] [8200–26 000]

HIV incidence per 1000 population 1.83 [1.07–3.13] 1.24 [0.73–2.12] 1.02 [0.6–1.75]

AIDS-related deaths
56 000 38 000 25 000
AIDS-related deaths (all ages)
[41 000–86 000] [27 000–57 000] [18 000–38 000]
16 000 8300 5200
AIDS-related deaths (0–14)
[8900–26 000] [4700–14 000] [3000–8800]
25 000 13 000 9100
AIDS-related deaths (women, 15+)
[18 000–39 000] [9400–20 000] [6700–14 000]
15 000 16 000 11 000
AIDS-related deaths (men, 15+)
[11 000–24 000] [12 000–25 000] [7700–17 000]

People living with HIV


1 500 000 1 500 000 1 600 000
People living with HIV (all ages)
[1 200 000–1 800 000] [1 300 000–1 800 000] [1 300 000–1 900 000]
210 000 150 000 120 000
People living with HIV (0–14)
[160 000–270 000] [120 000–190 000] [95 000–160 000]
780 000 860 000 910 000
People living with HIV (women, 15+)
[660 000–930 000] [730 000–1 000 000] [770 000–1 100 000]
490 000 520 000 530 000
People living with HIV (men, 15+)
[410 000–590 000] [440 000–620 000] [450 000–640 000]
HIV prevalence (15–49) 6 [5.1–7.1] 5.2 [4.4–6.2] 4.7 [4–5.7]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2009 2014
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
27.9 11.9
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2009 2014
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 31.7 25.5
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $91 422 168 $342 351 186 $615 277 224 $121 902 916 $3 931 091 $1 174 884 586

46
EPIDEMIC TRANSITION METRICS

250 000 250 000 15% 200 000


Number of people

Number of people
200 000

Number of people
200 000
150 000
10%
150 000 150 000

Percent
100 000
100 000 100 000
5%
50 000 50 000 50 000

0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -30% related deaths = -55% prevalence = 3%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 45 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [27 000
who have inject drugs people cases among people living with HIV (2017)
–68 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence ... ... ... ... ...
Cervical cancer screening of women living
Know their HIV status 95.5% ... 94.0% ... ...
with HIV
Antiretroviral therapy coverage 73.0% 62.8% 67.6% ... ...
People coinfected with HIV and hepatitis B
Condom use 92.0% ... 75.9% ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $4 559 192 $2 609 663 $5 231 623
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 600 000 100% people aged 15–24 years (2014)

1 400 000 Gap to ― Women 56.6%


Number of people living with HIV

reaching the
1 200 000 Gap to 75% ― Men 63.7%
first 90:
1 000 000 11 300 reaching the
first and Condom use at last sex with a non-marital,
800 000 second 90: 50% non-cohabiting partner (2014)
196 000
600 000 ― Women 40%
400 000 25% ― Men 44.5%
200 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 70.8%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2014)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
92.6%
All ages 89% [76– >95%] 68% [58–82%] ...% [...–...%] (2014)
1 068 000 Voluntary medical male circumcisions
performed according to national standards 286 899
Children (0–14) 61% [47–78%] 61% [47–78%] 54% [42–70%]
(2018)
74 300
People who received PrEP at least once
31 313
Women (15+) 94% [79– >95%] 75% [64–90%] ...% [...–...%] during the reporting period (2018)
681 000
Harm reduction
Men (15+) 88% [75– >95%] 59% [50–71%] ...% [...–...%]
313 000 ― Use of sterile injecting equipment at
88.4%
last injection (2017)
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 137
person who injects (2018)
2010 2018 ― Coverage of opioid substitution
26.4%
Percentage of pregnant women living with HIV 50% 91% therapy (2018)
accessing antiretroviral medicines [39–63%] [70– >95%]
― Naloxone available (2019) No
67.1% 67.3%
Early infant diagnosis
[53.1–87.2%] [53.3–87.4%] ― Safe injection rooms available (2019) Yes

47
LESOTHO COUNTRY DATA

LESOTHO

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
20 000 17 000 13 000
New HIV infections (all ages)
[18 000–21 000] [15 000–18 000] [11 000–15 000]
2100 1300 1300
New HIV infections (0–14)
[1600–2500] [900–1800] [780–1800]
10 000 8600 6600
New HIV infections (women, 15+)
[8700–11 000] [7300–9700] [5500–7800]
7600 6700 5200
New HIV infections (men, 15+)
[6700–8800] [5700–7900] [4200–6300]

HIV incidence per 1000 population 12.36 [10.93–13.48] 10.07 [8.77–11.3] 7.8 [6.69–9.15]

AIDS-related deaths
7200 8200 6100
AIDS-related deaths (all ages)
[5600–10 000] [6600–11 000] [5000–7600]
1200 990 620
AIDS-related deaths (0–14)
[850–1400] [690–1300] [<500–870]
3100 3300 2600
AIDS-related deaths (women, 15+)
[2300–4300] [2500–4400] [2100–3200]
2900 4000 2800
AIDS-related deaths (men, 15+)
[2300–4700] [3200–6100] [2300–3900]

People living with HIV


300 000 330 000 340 000
People living with HIV (all ages)
[280 000–320 000] [310 000–350 000] [320 000–360 000]
15 000 13 000 12 000
People living with HIV (0–14)
[13 000–17 000] [11 000–15 000] [9500–14 000]
170 000 190 000 190 000
People living with HIV (women, 15+)
[160 000–180 000] [180 000–200 000] [180 000–210 000]
120 000 130 000 130 000
People living with HIV (men, 15+)
[110 000–130 000] [120 000–140 000] [120 000–150 000]
HIV prevalence (15–49) 24.1 [22.7–24.9] 24.5 [22.3–25.5] 23.6 [21.2–24.7]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2009 2014
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV
22.8 13.9
adults regulations or is not criminalized

Percentage of people living with HIV denied 2013


Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in
the last 12 months 4

Drug use or possession for personal use is an


... 2013
offence Percentage of people living with HIV who
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people 3.7
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 ... $20 847 761 $63 885 192 $25 882 601 $3 995 002 $114 610 556

48
EPIDEMIC TRANSITION METRICS

50 000 25 000 20% 40 000


Number of people

Number of people
40 000

Number of people
20 000 15% 30 000
30 000 15 000

Percent
10% 20 000
20 000 10 000
10 000 5 000 5% 10 000

0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -34% related deaths = -16% prevalence = 4%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 11 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [6700
who have inject drugs people cases among people living with HIV (2017)
–15 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 71.9% 32.9% ... ... 31.4%
Cervical cancer screening of women living
Know their HIV status 63.8% 82.2% ... ... 29%
with HIV (survey data) (2014)
Antiretroviral therapy coverage ... ... ... ... 80.1%
People coinfected with HIV and hepatitis B
Condom use 62.3% 46.4% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and 8.0% 8.0% ... ...
discrimination
HIV PREVENTION
Expenditures (2014) $0 $0 $0
Adults aged 15+ years with unsuppressed
10.3%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


350 000 100% people aged 15–24 years (2014)

300 000 Gap to ― Women 37.6%


Number of people living with HIV

reaching the 75% ― Men 30.9%


250 000 first 90: Gap to
14 500 reaching the Gap to
200 000 Condom use at last sex with a non-marital,
first and reaching all
three 90s: 50% non-cohabiting partner (2014)
150 000 second 90:
69 600 56 200
― Women 76%
100 000
25% ― Men 76.6%
50 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 78.9%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2014)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
72.3%
All ages 86% [80–92%] 61% [57–65%] 57% [53–60%] (2014)
206 000 Voluntary medical male circumcisions
performed according to national standards 26 448
Children (0–14) 82% [64–95%] 70% [55–81%] 62% [48–71%]
(2018)
8500
People who received PrEP at least once
7279
Women (15+) 89% [83–95%] 65% [61–69%] 61% [57–65%] during the reporting period (2018)
125 000
Harm reduction
Men (15+) 82% [75–89%] 54% [49–59%] 49% [45–54%]
72 400 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 68% 77% therapy
accessing antiretroviral medicines [55–79%] [59–89%]
― Naloxone available (2019) No
92.5% 69.5%
Early infant diagnosis
[79.8– >95%] [60.0–90.4%] ― Safe injection rooms available (2019) No

49
MADAGASCAR COUNTRY DATA

MADAGASCAR

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
2100 4000 6100
New HIV infections (all ages)
[1700–2600] [2900–5600] [3800–11 000]
<500 <500 <500
New HIV infections (0–14)
[<500– <500] [<500– <500] [<500–730]
540 1100 1700
New HIV infections (women, 15+)
[<500–690] [770–1600] [1000–3100]
1300 2600 4000
New HIV infections (men, 15+)
[1000–1600] [1900–3700] [2500–7200]

HIV incidence per 1000 population 0.1 [0.08–0.12] 0.17 [0.12–0.24] 0.24 [0.15–0.43]

AIDS-related deaths
1400 1600 1700
AIDS-related deaths (all ages)
[1000–1700] [1200–2000] [1200–2300]
<200 <500 <500
AIDS-related deaths (0–14)
[<200– <500] [<200– <500] [<500– <500]
<500 <500 <500
AIDS-related deaths (women, 15+)
[<500– <500] [<500– <500] [<500–510]
850 980 1000
AIDS-related deaths (men, 15+)
[650–1100] [750–1200] [760–1500]

People living with HIV


21 000 28 000 39 000
People living with HIV (all ages)
[18 000–24 000] [23 000–35 000] [30 000–55 000]
1400 1700 1900
People living with HIV (0–14)
[1200–1700] [1400–2000] [1600–2500]
5900 8300 12 000
People living with HIV (women, 15+)
[5100–7000] [6900–10 000] [9000–16 000]
14 000 18 000 25 000
People living with HIV (men, 15+)
[12 000–16 000] [15 000–23 000] [19 000–37 000]
HIV prevalence (15–49) 0.2 [0.2–0.2] 0.2 [0.2–0.3] 0.3 [0.2–0.4]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Laws penalizing same-sex sexual Percentage of people living with HIV denied
Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in
never existed the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $2901 $289 872 ... $4 405 954 $1 067 746 $11 981 599

50
EPIDEMIC TRANSITION METRICS

12 000 2 500 30% 8 000


10 000 25%
Number of people

Number of people

Number of people
2 000
6 000
8 000 20%
1 500

Percent
6 000 15% 4 000
1 000
4 000 10%
500 2 000
2 000 5%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = 193% related deaths = 22% prevalence = 16%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and
other men People who Transgender
Estimated number of incident tuberculosis 1500
Sex workers Prisoners cases among people living with HIV (2017) [690–2700]
who have inject drugs people
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 8.9%
preventive therapy (2017)
HIV prevalence 5.5% 14.9% 8.5% ... 0.3%
Cervical cancer screening of women living
Know their HIV status 40.6% 19.3% 20.6% ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 62.8% 57.2% 41.8% ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $198 919 $105 376 $14 599
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


40 000 100% people aged 15–24 years (2015)

35 000 ― Women 22.9%


Number of people living with HIV

30 000 75% ― Men 25.5%


25 000
Condom use at last sex with a non-marital,
20 000 Gap to 50% non-cohabiting partner
reaching the Gap to
15 000 reaching the ― Women ...
first 90:
10 000 30 900 first and
25% ― Men ...
second 90:
5 000 28 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed
Not
Men aged 15–49 years who are circumcised
All ages 11% [8–15%] 9% [7–13%] ...% [...–...%] applicable
3500
Voluntary medical male circumcisions Not
Children (0–14) 5% [4–6%] 5% [4–6%] ...% [...–...%] performed according to national standards applicable
90
People who received PrEP at least once
...
Women (15+) 21% [16–30%] 16% [12–22%] ...% [...–...%] during the reporting period
1800
Harm reduction
Men (15+) 7% [5–9%] 6% [5–9%] ...% [...–...%]
1600 ― Use of sterile injecting equipment at
68.4%
last injection (2016)
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 8
person who injects (2017)
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 3% 25% therapy
accessing antiretroviral medicines [2–3%] [19–36%]
― Naloxone available (2019) No
...% ...%
Early infant diagnosis
[...–...%] [...–...%] ― Safe injection rooms available (2019) No

51
MALAWI COUNTRY DATA

MALAWI

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
55 000 44 000 38 000
New HIV infections (all ages)
[51 000–59 000] [40 000–48 000] [33 000–45 000]
15 000 6400 3500
New HIV infections (0–14)
[11 000–18 000] [3800–8600] [2900–5100]
23 000 21 000 20 000
New HIV infections (women, 15+)
[21 000–25 000] [19 000–24 000] [17 000–23 000]
18 000 16 000 15 000
New HIV infections (men, 15+)
[16 000–20 000] [15 000–19 000] [13 000–18 000]

HIV incidence per 1000 population 4.26 [3.94–4.59] 2.89 [2.63–3.19] 2.28 [1.97–2.68]

AIDS-related deaths
29 000 14 000 13 000
AIDS-related deaths (all ages)
[25 000–33 000] [12 000–18 000] [11 000–16 000]
11 000 4300 2600
AIDS-related deaths (0–14)
[8100–13 000] [2800–5700] [1800–3500]
9800 4700 5000
AIDS-related deaths (women, 15+)
[8000–12 000] [3800–5800] [4100–6000]
8700 5500 5500
AIDS-related deaths (men, 15+)
[7300–10 000] [4400–6800] [4500–6700]

People living with HIV


870 000 990 000 1 000 000
People living with HIV (all ages)
[770 000–960 000] [870 000–1 100 000] [940 000–1 100 000]
110 000 90 000 74 000
People living with HIV (0–14)
[90 000–120 000] [69 000–100 000] [57 000–89 000]
450 000 540 000 580 000
People living with HIV (women, 15+)
[400 000–500 000] [480 000–580 000] [520 000–620 000]
310 000 360 000 390 000
People living with HIV (men, 15+)
[270 000–340 000] [320 000–390 000] [350 000–430 000]
HIV prevalence (15–49) 10.6 [9.3–11.7] 9.8 [8.7–10.7] 9.2 [8–10]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non- No, but prosecutions exist based
Percentage of women and men aged 15–49 2010 2016
disclosure of or exposure to HIV transmission on general criminal laws
years who report discriminatory attitudes
Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV
16.5 17.6
adults regulations or is not criminalized

Percentage of people living with HIV denied 2016


Criminalization of same-sex sexual acts Yes, imprisonment (14 years - life) health services because of their HIV status in
the last 12 months 1.7

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are 2016
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people ... 6.1

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2010 2016
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 22.1 24.3
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


Yes
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 ... $5 594 173 $114 934 352 $89 842 549 $8 070 474 $218 441 548

52
EPIDEMIC TRANSITION METRICS

100 000 80 000 12% 100 000


10%
Number of people

Number of people
80 000

Number of people
60 000 80 000
8%
60 000

Percent
60 000
40 000 6%
40 000 40 000
4%
20 000 20 000
2% 20 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -30% related deaths = -55% prevalence = 4%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 12 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [7800
who have inject drugs people cases among people living with HIV (2017)
–17 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... 15 000 ...
preventive therapy (2017)
HIV prevalence 55.0% 7.0% ... ... 16.0%
Cervical cancer screening of women living
Know their HIV status 67.3% 64.0% ... 36.0% 18.7%
with HIV (survey data) (2016)
Antiretroviral therapy coverage 91.0% ... ... ... 100%
People coinfected with HIV and hepatitis B
Condom use 65.0% 44.0% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
68.0% 65.0% ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $1 351 953 $875 449 $0
Adults aged 15+ years with unsuppressed
2.7%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 000 000 100% people aged 15–24 years (2016)
900 000 Gap to
reaching the ― Women 41.1%
Gap to
Number of people living with HIV

800 000 first 90: reaching the Gap to 75% ― Men 44.3%
700 000 3700 first and reaching all
600 000 second 90: three 90s: Condom use at last sex with a non-marital,
500 000 35 100 38 800 50% non-cohabiting partner (2016)
400 000
― Women 49.9%
300 000
25% ― Men 76.3%
200 000
100 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 73.9%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
27.8%
All ages 90% [80– >95%] 78% [70–84%] 69% [62–75%] (2016)
814 000 Voluntary medical male circumcisions
performed according to national standards 199 399
Children (0–14) 61% [47–73%] 61% [47–73%] 35% [27–42%]
(2018)
45 100
People who received PrEP at least once
...
Women (15+) 94% [84– >95%] 86% [78–92%] 79% [71–85%] during the reporting period
502 000
Harm reduction
Men (15+) 89% [79– >95%] 68% [61–74%] 61% [54–66%]
267 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 26% >95% therapy
accessing antiretroviral medicines [20–30%] [80– >95%]
― Naloxone available (2019) No
...% >95%
Early infant diagnosis
[...–...%] [84.1– >95%] ― Safe injection rooms available (2019) No

53
MAURITIUS COUNTRY DATA

MAURITIUS

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
980 850 910
New HIV infections (all ages)
[720–1200] [540–1200] [560–1300]
<100 <100 <100
New HIV infections (0–14)
[<100– <100] [<100– <100] [<100– <100]
<500 <500 <500
New HIV infections (women, 15+)
[<500– <500] [<200– <500] [<200– <500]
680 590 630
New HIV infections (men, 15+)
[<500–890] [<500–830] [<500–940]

HIV incidence per 1000 population 0.78 [0.58–0.99] 0.66 [0.42–0.91] 0.7 [0.43–1.01]

AIDS-related deaths
<500 <500 610
AIDS-related deaths (all ages)
[<500–680] [<500–570] [<500–820]
<100 <100 <100
AIDS-related deaths (0–14)
[<100– <100] [<100– <100] [<100– <100]
<200 <200 <200
AIDS-related deaths (women, 15+)
[<200– <500] [<200– <500] [<200– <500]
<500 <500 <500
AIDS-related deaths (men, 15+)
[<500– <500] [<200– <500] [<500–570]

People living with HIV


11 000 12 000 13 000
People living with HIV (all ages)
[9500–12 000] [10 000–14 000] [10 000–15 000]
<200 <200 <100
People living with HIV (0–14)
[<100– <200] [<100– <200] [<100– <200]
3200 3600 3800
People living with HIV (women, 15+)
[2800–3600] [3100–4100] [3100–4500]
7200 8200 8600
People living with HIV (men, 15+)
[6300–8400] [7000–9700] [7000–11 000]
HIV prevalence (15–49) 1.3 [1.2–1.4] 1.3 [1.2–1.4] 1.3 [1.1–1.5]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
No Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Percentage of people living with HIV denied 2013


Criminalization of same-sex sexual acts Yes, penalty not specified health services because of their HIV status in
the last 12 months 28.9

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are 2013
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people 27.9
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
Yes VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


Yes
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2018 ... $5 628 025 ... $1 921 622 ... $7 549 647

54
EPIDEMIC TRANSITION METRICS

2 000 1 000 60% 1 500


50%
Number of people

Number of people

Number of people
1 500 800
40% 1 000
600

Percent
1 000 30%
400
20% 500
500 200 10%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -7% related deaths = 25% prevalence = 7%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and
other men People who Transgender
Estimated number of incident tuberculosis 27
Sex workers Prisoners cases among people living with HIV (2017) [18–39]
who have inject drugs people
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 0%
preventive therapy (2017)
HIV prevalence 15.0% 17.2% 32.3% 28.4% 17.3%
Cervical cancer screening of women living
Know their HIV status 78.9% 86.6% 71.1% ... ...
with HIV
Antiretroviral therapy coverage ... ... 51.7% ... 79.1%
People coinfected with HIV and hepatitis B
Condom use 67.2% 53.1% 45.4% 45.4% 100%
virus receiving combined treatment (2018)
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
4%
virus starting hepatitis C treatment (2018)
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
1%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


12 000 100% people aged 15–24 years (2014)

― Women 4.4%
10 000
Number of people living with HIV

75% ― Men 30%


8 000
Gap to Condom use at last sex with a non-marital,
Gap to
6 000 reaching the 50% non-cohabiting partner
reaching the Gap to
first 90:
first and reaching all ― Women ...
4 000 8500
second 90: three 90s:
7400 7100 25% ― Men ...
2 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed
Not
Men aged 15–49 years who are circumcised
All ages 22% [18–26%] 22% [18–26%] 16% [13–19%] applicable
2800
Voluntary medical male circumcisions Not
Children (0–14) 45% [40–50%] 45% [40–50%] 30% [26–33%] performed according to national standards applicable
40
People who received PrEP at least once
3
Women (15+) 19% [16–23%] 19% [16–23%] 13% [11–16%] during the reporting period (2018)
720
Harm reduction
Men (15+) 23% [19–28%] 23% [19–28%] 17% [14–21%]
2000 ― Use of sterile injecting equipment at
92.2%
last injection (2017)
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 89
person who injects (2018)
2010 2018 ― Coverage of opioid substitution
53.6%
Percentage of pregnant women living with HIV 69% >95% therapy (2018)
accessing antiretroviral medicines [60–79%] [>95– >95%]
― Naloxone available (2019) No
...% 75.3%
Early infant diagnosis
[...–...%] [60.4– >95%] ― Safe injection rooms available (2019) No

55
MOZAMBIQUE COUNTRY DATA

MOZAMBIQUE

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
160 000 150 000 150 000
New HIV infections (all ages)
[97 000–240 000] [93 000–230 000] [90 000–220 000]
28 000 17 000 16 000
New HIV infections (0–14)
[17 000–47 000] [11 000–29 000] [10 000–27 000]
75 000 76 000 73 000
New HIV infections (women, 15+)
[47 000–120 000] [48 000–120 000] [46 000–110 000]
53 000 57 000 55 000
New HIV infections (men, 15+)
[32 000–84 000] [34 000–89 000] [34 000–87 000]

HIV incidence per 1000 population 7.01 [4.26–11.09] 5.91 [3.59–9.34] 5.25 [3.2–8.32]

AIDS-related deaths
64 000 59 000 54 000
AIDS-related deaths (all ages)
[46 000–87 000] [42 000–80 000] [39 000–73 000]
16 000 9800 8700
AIDS-related deaths (0–14)
[9600–26 000] [6000–16 000] [5300–14 000]
28 000 25 000 21 000
AIDS-related deaths (women, 15+)
[19 000–39 000] [17 000–35 000] [14 000–30 000]
21 000 24 000 24 000
AIDS-related deaths (men, 15+)
[15 000–28 000] [18 000–33 000] [18 000–32 000]

People living with HIV


1 600 000 2 000 000 2 200 000
People living with HIV (all ages)
[1 300 000–1 900 000] [1 600 000–2 400 000] [1 700 000–2 700 000]
130 000 140 000 140 000
People living with HIV (0–14)
[100 000–180 000] [110 000–190 000] [110 000–190 000]
880 000 1 100 000 1 200 000
People living with HIV (women, 15+)
[710 000–1 100 000] [890 000–1 300 000] [1 000 000–1 500 000]
570 000 710 000 800 000
People living with HIV (men, 15+)
[450 000–710 000] [560 000–890 000] [630 000–1 000 000]
HIV prevalence (15–49) 12 [9.5–14.9] 12.5 [9.9–15.5] 12.6 [10–15.7]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2011 2015
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV
28 20.7
adults regulations or is not criminalized

Percentage of people living with HIV denied 2013


Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in
the last 12 months 3.4

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2011 2015
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 27.7 15.5
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2016 ... $8 501 812 $206 158 981 $84 130 028 $30 730 657 $329 521 478

56
EPIDEMIC TRANSITION METRICS

300 000 120 000 30% 200 000


250 000 25%
Number of people

100 000

Number of people

Number of people
150 000
200 000 80 000 20%

Percent
150 000 60 000 15% 100 000
100 000 40 000 10%
50 000
50 000 20 000 5%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -7% related deaths = -16% prevalence = 7%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 66 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [42 000
who have inject drugs people cases among people living with HIV (2017)
–95 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence ... ... ... ... 24.0%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use ... ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2016) $3 244 170 $479 004 $17 746
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


2 500 000 100% people aged 15–24 years (2015)

― Women 30.8%
Number of people living with HIV

2 000 000
75% ― Men 30.2%
Gap to
1 500 000 reaching the
Gap to Condom use at last sex with a non-marital,
first 90:
reaching the 50% non-cohabiting partner (2015)
392 000
first and
1 000 000
second 90: ― Women 42%
557 000
25% ― Men 46.5%
500 000

Women aged 15–49 years who have their


0 0% demand for family planning satisfied by 55.5%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2015)
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 72% [58–89%] 56% [44–68%] ...% [...–...%]
1 213 000 Voluntary medical male circumcisions
performed according to national standards 311 891
Children (0–14) 60% [45–81%] 60% [45–81%] ...% [...–...%]
(2018)
86 900
People who received PrEP at least once
1934
Women (15+) 80% [65– >95%] 64% [51–77%] ...% [...–...%] during the reporting period (2018)
791 000
Harm reduction
Men (15+) 61% [48–77%] 42% [33–53%] ...% [...–...%]
334 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 23% >95% therapy
accessing antiretroviral medicines [17–31%] [73– >95%]
― Naloxone available (2019) Yes
36.1% 66.4%
Early infant diagnosis
[27.3–50.2%] [50.2–92.3%] ― Safe injection rooms available (2019) No

57
NAMIBIA COUNTRY DATA

NAMIBIA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
9900 7600 6100
New HIV infections (all ages)
[8700–11 000] [6600–8600] [5200–7000]
1400 1100 <500
New HIV infections (0–14)
[900–1700] [630–1400] [<500–610]
4900 3800 3300
New HIV infections (women, 15+)
[4200–5400] [3200–4300] [2700–3800]
3600 2800 2500
New HIV infections (men, 15+)
[3000–4300] [2300–3300] [2000–3000]

HIV incidence per 1000 population 5.42 [4.72–5.92] 3.77 [3.2–4.31] 2.82 [2.34–3.27]

AIDS-related deaths
3500 2500 2700
AIDS-related deaths (all ages)
[3000–3900] [2200–3000] [2300–3200]
770 520 <500
AIDS-related deaths (0–14)
[540–990] [<500–780] [<200– <500]
1500 1100 1400
AIDS-related deaths (women, 15+)
[1300–1800] [900–1200] [1100–1700]
1200 930 990
AIDS-related deaths (men, 15+)
[980–1400] [780–1100] [830–1200]

People living with HIV


170 000 190 000 200 000
People living with HIV (all ages)
[160 000–180 000] [180 000–210 000] [190 000–220 000]
13 000 13 000 11 000
People living with HIV (0–14)
[11 000–15 000] [10 000–15 000] [8700–13 000]
96 000 110 000 110 000
People living with HIV (women, 15+)
[87 000–100 000] [100 000–120 000] [110 000–120 000]
63 000 72 000 76 000
People living with HIV (men, 15+)
[57 000–68 000] [66 000–77 000] [69 000–82 000]
HIV prevalence (15–49) 13.4 [12.2–14.2] 12.6 [11.4–13.3] 11.8 [10.6–12.7]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non- No, but prosecutions exist based
Percentage of women and men aged 15–49 2007 2013
disclosure of or exposure to HIV transmission on general criminal laws
years who report discriminatory attitudes
Criminalization of sex work among consenting towards people living with HIV
... 23.1 13
adults

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, penalty not specified health services because of their HIV status in
the last 12 months

Drug use or possession for personal use is an


...
offence Percentage of people living with HIV who
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2013
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 20.2
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $74 920 120 $124 497 810 $61 448 180 $20 839 710 $1 122 120 $282 827 940

58
EPIDEMIC TRANSITION METRICS

25 000 14 000 15% 20 000


12 000
Number of people

Number of people
20 000

Number of people
10 000 15 000
10%
15 000

Percent
8 000
10 000
10 000 6 000
4 000 5%
5 000 5 000
2 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


Incidence:
HIV infections = -38% related deaths = -22% prevalence = 3% mortality ratio = 1.5
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 3900
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [2500
who have inject drugs people cases among people living with HIV (2017)
–5500]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 14.8%
preventive therapy (2017)
HIV prevalence 40.7% ... ... ... ...
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use ... ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
1.5%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


186 000 100% people aged 15–24 years

184 000 ― Women ...


Number of people living with HIV

182 000 75% ― Men ...


180 000
Condom use at last sex with a non-marital,
178 000 50% non-cohabiting partner
176 000 ― Women ...
174 000 25% ― Men ...
172 000
Women aged 15–49 years who have their
170 000 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 91% [84– >95%] 92% [84– >95%] 87% [80–94%]
184 000 Voluntary medical male circumcisions
performed according to national standards 34 942
Children (0–14) 78% [61–89%] 78% [61–89%] 67% [53–77%]
(2018)
8600
People who received PrEP at least once
190
Women (15+) 95% [88– >95%] >95% [>95– >95%] >95% [92– >95%] during the reporting period (2017)
117 000
Harm reduction
Men (15+) 87% [80–95%] 77% [70–83%] 72% [66–78%]
58 200 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 67% >95% therapy
accessing antiretroviral medicines [55–77%] [92– >95%]
― Naloxone available (2019) No
43.0% ...%
Early infant diagnosis
[37.4–52.2%] [...–...%] ― Safe injection rooms available (2019) No

59
RWANDA COUNTRY DATA

RWANDA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
9000 5000 3600
New HIV infections (all ages)
[7600–10 000] [3700–6300] [2400–4800]
2200 510 <500
New HIV infections (0–14)
[1400–2700] [<500–840] [<500–700]
4000 2600 1900
New HIV infections (women, 15+)
[3200–4600] [1900–3300] [1300–2500]
2800 1800 1300
New HIV infections (men, 15+)
[2300–3600] [1400–2500] [910–1800]

HIV incidence per 1000 population 0.91 [0.76–1.04] 0.43 [0.33–0.55] 0.29 [0.2–0.39]

AIDS-related deaths
5700 3400 2900
AIDS-related deaths (all ages)
[4700–7100] [2700–4200] [2400–3500]
1500 560 <500
AIDS-related deaths (0–14)
[1100–1900] [<500–830] [<200–540]
2200 1500 1300
AIDS-related deaths (women, 15+)
[1700–2800] [1200–1800] [1100–1700]
2100 1400 1200
AIDS-related deaths (men, 15+)
[1700–2700] [1100–1800] [1000–1500]

People living with HIV


220 000 220 000 220 000
People living with HIV (all ages)
[200 000–250 000] [200 000–250 000] [200 000–250 000]
21 000 15 000 12 000
People living with HIV (0–14)
[18 000–24 000] [12 000–19 000] [8900–15 000]
120 000 130 000 130 000
People living with HIV (women, 15+)
[110 000–140 000] [110 000–140 000] [120 000–150 000]
78 000 81 000 81 000
People living with HIV (men, 15+)
[68 000–89 000] [70 000–91 000] [70 000–90 000]
HIV prevalence (15–49) 3.3 [2.8–3.7] 2.9 [2.4–3.2] 2.5 [2.1–2.8]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
... Percentage of women and men aged 15–49 2010 2015
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting towards people living with HIV
... 14.4 9.9
adults

Laws penalizing same-sex sexual Percentage of people living with HIV denied
Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in
never existed the last 12 months

Drug use or possession for personal use is an


...
offence Percentage of people living with HIV who
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people ...

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV
... Proportion of ever-married or partnered 2010 2015
testing
women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
... intimate partner in the past 12 months 44.3 20.7
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2015 ... $19 877 495 $97 029 539 $95 605 601 $5 077 320 $217 589 955

60
EPIDEMIC TRANSITION METRICS

30 000 25 000 12% 25 000


25 000 10%
Number of people

Number of people

Number of people
20 000 20 000
20 000 8%
15 000

Percent
15 000
15 000 6%
10 000 10 000
10 000 4%
5 000 5 000 2% 5 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


Incidence:
HIV infections = -61% related deaths = -50% prevalence = 2% mortality ratio = 0.9
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and
other men People who Transgender
Estimated number of incident tuberculosis 1500
Sex workers Prisoners cases among people living with HIV (2017) [980–2200]
who have inject drugs people
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 45.8% 4.0% ... ... ...
Cervical cancer screening of women living
Know their HIV status 95.1% 83.0% ... ... ...
with HIV
Antiretroviral therapy coverage 36.3% ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 84.3% 71.4% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2015) $218 310 $240 246 $0
Adults aged 15+ years with unsuppressed
0.7%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


250 000 100% people aged 15–24 years (2015)

― Women 64.6%
Number of people living with HIV

200 000
75% ― Men 64.3%

150 000 Condom use at last sex with a non-marital,


50% non-cohabiting partner (2015)
100 000
― Women 47.5%
25% ― Men 65.9%
50 000

Women aged 15–49 years who have their


0 0% demand for family planning satisfied by 63.9%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2015)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
29.6%
All ages 94% [83– >95%] 87% [76– >95%] 74% [65–82%] (2015)
194 000 Voluntary medical male circumcisions
performed according to national standards 327 904
Children (0–14) 63% [47–80%] 63% [47–80%] 43% [32–55%]
(2018)
7500
People who received PrEP at least once
...
Women (15+) >95% [85– >95%] 91% [80– >95%] 79% [70–88%] during the reporting period
119 000
Harm reduction
Men (15+) >95% [83– >95%] 84% [73–94%] 70% [62–79%]
67 600 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 58% >95% therapy
accessing antiretroviral medicines [44–69%] [79– >95%]
― Naloxone available (2019) ...
60.3% 82.5%
Early infant diagnosis
[50.7–79.4%] [71.0– >95%] ― Safe injection rooms available (2019) ...

61
SOUTH AFRICA COUNTRY DATA

SOUTH AFRICA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
390 000 300 000 240 000
New HIV infections (all ages)
[370 000–430 000] [270 000–330 000] [210 000–270 000]
28 000 15 000 14 000
New HIV infections (0–14)
[21 000–46 000] [12 000–26 000] [11 000–35 000]
220 000 170 000 140 000
New HIV infections (women, 15+)
[200 000–240 000] [150 000–190 000] [120 000–160 000]
150 000 110 000 86 000
New HIV infections (men, 15+)
[130 000–180 000] [99 000–130 000] [75 000–100 000]

HIV incidence per 1000 population 9.08 [8.55–9.81] 6.4 [5.9–7.09] 4.94 [4.43–5.51]

AIDS-related deaths
140 000 75 000 71 000
AIDS-related deaths (all ages)
[110 000–170 000] [58 000–96 000] [52 000–91 000]
18 000 7100 4400
AIDS-related deaths (0–14)
[11 000–28 000] [4900–10 000] [1900–15 000]
69 000 37 000 33 000
AIDS-related deaths (women, 15+)
[53 000–84 000] [27 000–48 000] [23 000–45 000]
56 000 31 000 33 000
AIDS-related deaths (men, 15+)
[45 000–75 000] [24 000–44 000] [26 000–46 000]

People living with HIV


6 100 000 7 200 000 7 700 000
People living with HIV (all ages)
[5 500 000–6 600 000] [6 600 000–7 700 000] [7 100 000–8 300 000]
320 000 290 000 260 000
People living with HIV (0–14)
[250 000–370 000] [220 000–370 000] [200 000–360 000]
3 600 000 4 300 000 4 700 000
People living with HIV (women, 15+)
[3 200 000–3 900 000] [4 000 000–4 600 000] [4 300 000–5 000 000]
2 200 000 2 600 000 2 800 000
People living with HIV (men, 15+)
[2 000 000–2 500 000] [2 400 000–2 900 000] [2 500 000–3 100 000]
HIV prevalence (15–49) 18.9 [16.8–20.7] 20.3 [17.6–22.3] 20.4 [17.4–22.5]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
... Percentage of women and men aged 15–49 2017
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
12.6
adults regulation of sex work

Laws penalizing same-sex sexual Percentage of people living with HIV denied 2014
Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in
never existed the last 12 months 3.2

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2012 2017
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 5.1 30.3
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $0 $1 545 826 721 $472 582 374 $54 863 457 $10 070 103 $2 021 895 609

62
EPIDEMIC TRANSITION METRICS

700 000 300 000 20% 600 000


600 000
Number of people

250 000

Number of people

Number of people
500 000 15%
200 000 400 000

Percent
400 000
150 000 10%
300 000
200 000 100 000 200 000
5%
100 000 50 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -40% related deaths = -50% prevalence = 3%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 193 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [137 000
who have inject drugs people cases among people living with HIV (2017)
–258 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 52.9%
preventive therapy (2017)
HIV prevalence 57.7% 18.1% 21.8% ... 8.9%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage 23.6% 28.1% ... ... 98.8%
People coinfected with HIV and hepatitis B
Condom use 86.1% 97.9% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (2017) $10 491 195 $2 093 180 $4 796 756
Adults aged 15+ years with unsuppressed
8.5%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


8 000 000 100% people aged 15–24 years (2016)

7 000 000 ― Women 46.1%


Number of people living with HIV

6 000 000 75% ― Men 45.6%


5 000 000 Gap to
Gap to viral Condom use at last sex with a non-marital,
treatment
suppression
4 000 000 target: 50% non-cohabiting partner (2016)
target:
1 481 000
3 000 000 1 478 000 ― Women 61.4%
2 000 000 25% ― Men 73.1%
1 000 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 79.7%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 90% [83– >95%] 62% [57–66%] 54% [49–58%]
4 788 000 Voluntary medical male circumcisions
performed according to national standards 572 442
Children (0–14) 76% [59– >95%] 63% [49–87%] 46% [36–64%]
(2018)
163 000
People who received PrEP at least once
8184
Women (15+) 93% [86– >95%] 65% [60–70%] 58% [54–62%] during the reporting period (2018)
3 057 000
Harm reduction
Men (15+) 88% [79– >95%] 56% [50–60%] 47% [42–51%]
1 568 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 65% 87% therapy
accessing antiretroviral medicines [48–79%] [63– >95%]
― Naloxone available (2019) ...
65.7% 88.7%
Early infant diagnosis
[54.2–88.1%] [73.3– >95%] ― Safe injection rooms available (2019) ...

63
SOUTH SUDAN COUNTRY DATA

SOUTH SUDAN

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
14 000 17 000 19 000
New HIV infections (all ages)
[11 000–18 000] [12 000–22 000] [13 000–27 000]
2900 2600 2700
New HIV infections (0–14)
[2100–3800] [1700–3600] [1600–3900]
6600 8200 9500
New HIV infections (women, 15+)
[4800–8100] [5600–11 000] [6200–13 000]
4900 6100 7100
New HIV infections (men, 15+)
[3600–6200] [4100–8200] [4700–10 000]

HIV incidence per 1000 population 1.51 [1.13–1.89] 1.49 [1.01–1.96] 1.56 [1.03–2.18]

AIDS-related deaths
9800 9800 9900
AIDS-related deaths (all ages)
[7300–13 000] [7200–12 000] [6900–13 000]
2000 2000 1900
AIDS-related deaths (0–14)
[1600–2600] [1400–2600] [1200–2600]
4500 4200 4400
AIDS-related deaths (women, 15+)
[3200–5900] [3000–5400] [3000–5700]
3300 3700 3500
AIDS-related deaths (men, 15+)
[2400–4400] [2700–4800] [2500–4700]

People living with HIV


140 000 170 000 190 000
People living with HIV (all ages)
[110 000–170 000] [130 000–210 000] [140 000–240 000]
15 000 16 000 16 000
People living with HIV (0–14)
[11 000–19 000] [12 000–21 000] [12 000–21 000]
73 000 90 000 100 000
People living with HIV (women, 15+)
[58 000–89 000] [69 000–110 000] [77 000–130 000]
53 000 64 000 73 000
People living with HIV (men, 15+)
[40 000–64 000] [47 000–78 000] [52 000–92 000]
HIV prevalence (15–49) 2.4 [1.9–3] 2.4 [1.8–3] 2.5 [1.9–3.1]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2012 ... $2 302 076 $12 287 166 $3 746 098 $2 473 180 $24 154 614

64
EPIDEMIC TRANSITION METRICS

30 000 14 000 20% 25 000


25 000 12 000
Number of people

Number of people

Number of people
15% 20 000
20 000 10 000

Percent
8 000 15 000
15 000 10%
6 000 10 000
10 000 4 000 5%
5 000 2 000 5 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = 35% related deaths = 0% prevalence = 10%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 2300
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [1400
who have inject drugs people cases among people living with HIV (2017)
–3300]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 24.0% ... ... ... ...
Cervical cancer screening of women living
Know their HIV status 57.1% ... ... ... ...
with HIV
Antiretroviral therapy coverage 75.3% ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 60.1% ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
16.3% ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


200 000 100% people aged 15–24 years
180 000 ― Women ...
Number of people living with HIV

160 000
75% ― Men ...
140 000
120 000 Condom use at last sex with a non-marital,
Gap to
100 000 reaching the Gap to
50% non-cohabiting partner
80 000 first 90: reaching the
― Women ...
60 000 128 000 first and
second 90: 25% ― Men ...
40 000
126 000
20 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by ...
People living with HIV who know People living with HIV on People living with HIV who are
modern methods
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 24% [18–30%] 16% [12–20%] ...% [...–...%]
30 700 Voluntary medical male circumcisions
performed according to national standards 1147
Children (0–14) 9% [7–12%] 9% [7–12%] ...% [...–...%]
(2018)
1500
People who received PrEP at least once
...
Women (15+) 28% [21–35%] 19% [14–23%] ...% [...–...%] during the reporting period
19 500
Harm reduction
Men (15+) 22% [16–27%] 13% [10–17%] ...% [...–...%]
9800 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 9% 56% therapy
accessing antiretroviral medicines [6–11%] [41–74%]
― Naloxone available (2019) No
...% 5.7%
Early infant diagnosis
[...–...%] [4.3–7.8%] ― Safe injection rooms available (2019) No

65
UGANDA COUNTRY DATA

UGANDA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
92 000 65 000 53 000
New HIV infections (all ages)
[82 000–110 000] [56 000–80 000] [44 000–67 000]
22 000 10 000 7500
New HIV infections (0–14)
[18 000–25 000] [8600–11 000] [5100–11 000]
41 000 31 000 26 000
New HIV infections (women, 15+)
[35 000–48 000] [27 000–39 000] [21 000–34 000]
30 000 23 000 19 000
New HIV infections (men, 15+)
[26 000–37 000] [20 000–31 000] [16 000–27 000]

HIV incidence per 1000 population 3.21 [2.82–3.76] 1.9 [1.63–2.34] 1.4 [1.15–1.82]

AIDS-related deaths
56 000 30 000 23 000
AIDS-related deaths (all ages)
[48 000–66 000] [25 000–38 000] [19 000–31 000]
16 000 8300 5500
AIDS-related deaths (0–14)
[13 000–18 000] [6800–9700] [4100–7300]
24 000 8600 7000
AIDS-related deaths (women, 15+)
[20 000–29 000] [6300–12 000] [5700–9800]
16 000 13 000 11 000
AIDS-related deaths (men, 15+)
[13 000–20 000] [11 000–18 000] [8300–15 000]

People living with HIV


1 200 000 1 300 000 1 400 000
People living with HIV (all ages)
[1 100 000–1 300 000] [1 200 000–1 400 000] [1 300 000–1 500 000]
140 000 120 000 100 000
People living with HIV (0–14)
[120 000–150 000] [100 000–130 000] [88 000–110 000]
620 000 720 000 770 000
People living with HIV (women, 15+)
[590 000–670 000] [680 000–780 000] [720 000–840 000]
430 000 490 000 510 000
People living with HIV (men, 15+)
[400 000–480 000] [450 000–540 000] [470 000–570 000]
HIV prevalence (15–49) 6.8 [6.5–7.1] 6.2 [5.9–6.5] 5.7 [5.4–6.1]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2011 2016
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
26.2 33.2
adults regulation of sex work

Percentage of people living with HIV denied 2013


Criminalization of same-sex sexual acts Yes, penalty not specified health services because of their HIV status in
the last 12 months 4.2

Drug use or possession for personal use is an


... 2013
offence Percentage of people living with HIV who
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people Criminalized 7

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2011 2016
testing 14 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 33.3 29.9
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2008 ... $38 693 159 ... $2 295 076 $246 205 640 $296 649 946

66
EPIDEMIC TRANSITION METRICS

120 000 120 000 12% 150 000


100 000 10%
Number of people

100 000

Number of people

Number of people
80 000 80 000 8% 100 000

Percent
60 000 60 000 6%
40 000 40 000 4% 50 000
20 000 20 000 2%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -43% related deaths = -58% prevalence = 4%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 34 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [22 000
who have inject drugs people cases among people living with HIV (2017)
–49 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 85.0% ... 26.7% ... 15.0%
Cervical cancer screening of women living
Know their HIV status 100% 85.0% 100% 84.0% ...
with HIV
Antiretroviral therapy coverage ... 66.0% 78.0% 13.0% 49.0%
People coinfected with HIV and hepatitis B
Condom use 69.4% ... 4.0% ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... 8.0% ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... 64.0% ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
2.1%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 400 000 100% people aged 15–24 years (2016)

1 200 000 Gap to ― Women 45.7%


Number of people living with HIV

reaching the Gap to 75%


1 000 000 ― Men 44.8%
first 90: reaching the Gap to
89 400 first and
800 000 reaching all Condom use at last sex with a non-marital,
second 90: three 90s: 50% non-cohabiting partner (2016)
600 000 120 000 129 000
― Women 38.3%
400 000
25% ― Men 62.4%
200 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 53.8%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed

Men aged 15–49 years who are circumcised ...


All ages 84% [78–90%] 72% [68–78%] 64% [60–69%]
1 004 000 Voluntary medical male circumcisions
performed according to national standards 619 082
Children (0–14) 66% [57–74%] 66% [57–74%] 46% [39–51%]
(2018)
67 100
People who received PrEP at least once
7526
Women (15+) 85% [80–92%] 79% [74–86%] 72% [67–77%] during the reporting period (2018)
614 000
Harm reduction
Men (15+) 84% [77–95%] 63% [58–71%] 55% [51–62%]
323 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 29% 93% therapy
accessing antiretroviral medicines [24–33%] [73– >95%]
― Naloxone available (2019) No
10.1% 44.8%
Early infant diagnosis
[8.8–12.0%] [39.4–56.6%] ― Safe injection rooms available (2019) No

67
UNITED REPUBLIC OF TANZANIA COUNTRY DATA

UNITED REPUBLIC OF TANZANIA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
83 000 81 000 72 000
New HIV infections (all ages)
[77 000–90 000] [72 000–90 000] [61 000–83 000]
9800 12 000 8600
New HIV infections (0–14)
[8200–12 000] [8800–17 000] [6500–13 000]
42 000 39 000 36 000
New HIV infections (women, 15+)
[38 000–46 000] [35 000–44 000] [31 000–42 000]
31 000 30 000 27 000
New HIV infections (men, 15+)
[28 000–36 000] [26 000–35 000] [23 000–33 000]

HIV incidence per 1000 population 2.08 [1.93–2.26] 1.74 [1.53–1.93] 1.41 [1.19–1.61]

AIDS-related deaths
48 000 29 000 24 000
AIDS-related deaths (all ages)
[42 000–53 000] [25 000–34 000] [20 000–29 000]
11 000 7100 5400
AIDS-related deaths (0–14)
[8900–13 000] [5000–9600] [3200–8900]
21 000 9100 7600
AIDS-related deaths (women, 15+)
[18 000–23 000] [7600–11 000] [6300–9100]
16 000 13 000 11 000
AIDS-related deaths (men, 15+)
[13 000–19 000] [11 000–16 000] [9300–14 000]

People living with HIV


1 300 000 1 400 000 1 600 000
People living with HIV (all ages)
[1 100 000–1 400 000] [1 300 000–1 600 000] [1 400 000–1 700 000]
120 000 98 000 92 000
People living with HIV (0–14)
[97 000–130 000] [80 000–120 000] [72 000–110 000]
670 000 800 000 880 000
People living with HIV (women, 15+)
[580 000–750 000] [720 000–880 000] [800 000–970 000]
470 000 540 000 580 000
People living with HIV (men, 15+)
[410 000–530 000] [470 000–600 000] [520 000–640 000]
HIV prevalence (15–49) 5 [4.3–5.7] 4.8 [4.2–5.3] 4.6 [4–5.1]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
adults regulation of sex work

Percentage of people living with HIV denied 2013


Criminalization of same-sex sexual acts Yes, imprisonment (14 years - life) health services because of their HIV status in
the last 12 months 8.7

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2010 2016
testing 18 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 35.3 29.6
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


Yes
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2005 $12 417 597 $108 120 344 ... $37 752 100 $108 081 035 $266 371 077

68
EPIDEMIC TRANSITION METRICS

140 000 120 000 12% 150 000


120 000 10%
Number of people

100 000

Number of people

Number of people
100 000
80 000 8% 100 000

Percent
80 000
60 000 6%
60 000
40 000 40 000 4% 50 000
20 000 20 000 2%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -13% related deaths = -49% prevalence = 5%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 48 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [31 000
who have inject drugs people cases among people living with HIV (2017)
–69 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... ...
preventive therapy (2017)
HIV prevalence 15.4% 8.4% ... ... 6.7%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... ...
with HIV
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 70.0% 13.9% ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
20.0% ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
1.8%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 600 000 100% people aged 15–24 years

1 400 000 ― Women ...


Number of people living with HIV

Gap to
1 200 000 reaching the Gap to 75% ― Men ...
first 90: reaching the Gap to
1 000 000
190 000 first and reaching all Condom use at last sex with a non-marital,
800 000 second 90: three 90s: 50% non-cohabiting partner (2017)
151 000 172 000
600 000 ― Women 30.3%
400 000 25% ― Men 46.5%
200 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 55.1%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2016)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
80.3%
All ages 78% [70–85%] 71% [64–78%] 62% [56–68%] (2016)
1 109 000 Voluntary medical male circumcisions
performed according to national standards 885 599
Children (0–14) 65% [51–80%] 65% [51–80%] 43% [34–52%]
(2018)
59 600
People who received PrEP at least once
...
Women (15+) 82% [74–90%] 82% [74–89%] 73% [66–80%] during the reporting period
721 000
Harm reduction
Men (15+) 73% [65–81%] 57% [50–63%] 49% [43–54%]
328 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 15
person who injects (2017)
2010 2018 ― Coverage of opioid substitution
20.8%
Percentage of pregnant women living with HIV 75% 93% therapy (2018)
accessing antiretroviral medicines [59–90%] [70– >95%]
― Naloxone available (2019) No
28.6% 46.9%
Early infant diagnosis
[23.9–36.7%] [39.3–62.2%] ― Safe injection rooms available (2019) No

69
ZAMBIA COUNTRY DATA

ZAMBIA

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
56 000 50 000 48 000
New HIV infections (all ages)
[40 000–79 000] [36 000–71 000] [34 000–69 000]
8800 6300 5400
New HIV infections (0–14)
[6300–12 000] [4600–8900] [3900–7600]
27 000 25 000 25 000
New HIV infections (women, 15+)
[19 000–38 000] [18 000–36 000] [17 000–35 000]
20 000 19 000 18 000
New HIV infections (men, 15+)
[14 000–30 000] [13 000–28 000] [13 000–27 000]

HIV incidence per 1000 population 4.55 [3.2–6.63] 3.42 [2.4–4.99] 2.97 [2.09–4.33]

AIDS-related deaths
26 000 18 000 17 000
AIDS-related deaths (all ages)
[21 000–35 000] [15 000–24 000] [13 000–22 000]
5900 3800 3000
AIDS-related deaths (0–14)
[3900–8400] [2500–5400] [2000–4200]
10 000 8100 7000
AIDS-related deaths (women, 15+)
[8100–13 000] [6400–11 000] [5600–9200]
10 000 6400 6600
AIDS-related deaths (men, 15+)
[8200–14 000] [5100–8600] [5200–8900]

People living with HIV


1 000 000 1 200 000 1 200 000
People living with HIV (all ages)
[900 000–1 100 000] [1 000 000–1 300 000] [1 100 000–1 400 000]
77 000 69 000 62 000
People living with HIV (0–14)
[64 000–91 000] [57 000–81 000] [52 000–74 000]
540 000 640 000 700 000
People living with HIV (women, 15+)
[490 000–610 000] [570 000–720 000] [630 000–790 000]
380 000 440 000 480 000
People living with HIV (men, 15+)
[340 000–440 000] [390 000–510 000] [420 000–550 000]
HIV prevalence (15–49) 13 [11.5–14.5] 12.1 [10.7–13.5] 11.3 [10–12.6]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non- No, but prosecutions exist based
Percentage of women and men aged 15–49 2007 2014
disclosure of or exposure to HIV transmission on general criminal laws
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
30 18
adults regulation of sex work

Percentage of people living with HIV denied


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months

Possession of drugs for personal use


Drug use or possession for personal use is an
or drug use and/or consumption are
offence Percentage of people living with HIV who
specified as criminal offences
reported a health-care professional told others
Neither criminalized nor about their HIV status without their consent
Criminalization of transgender people
prosecuted

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2007 2014
testing 16 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 42 26.7
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


No
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $1 179 334 $36 689 849 $251 767 599 $35 622 801 $114 530 358 $439 789 941

70
EPIDEMIC TRANSITION METRICS

120 000 100 000 15% 100 000


100 000
Number of people

Number of people

Number of people
80 000 80 000
80 000 10%
60 000

Percent
60 000
60 000
40 000 40 000
40 000 5%
20 000 20 000 20 000
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


HIV infections = -13% related deaths = -37% prevalence = 4%
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 36 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [23 000
who have inject drugs people cases among people living with HIV (2017)
–52 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 18.3%
preventive therapy (2017)
HIV prevalence 48.8% ... ... ... 27.4%
Cervical cancer screening of women living
Know their HIV status ... ... ... ... 27.3%
with HIV (survey data) (2016)
Antiretroviral therapy coverage ... ... ... ... ...
People coinfected with HIV and hepatitis B
Condom use 78.5% ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
... ... ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and ... ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
5%
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 200 000 100% people aged 15–24 years (2014)
Gap to
― Women 41.5%
1 000 000 reaching the
Number of people living with HIV

Gap to
first 90: reaching the 75% ― Men 46.7%
800 000 36 300 first and Gap to
second 90: reaching all Condom use at last sex with a non-marital,
600 000 40 600 three 90s: 50% non-cohabiting partner (2014)
178 000
400 000 ― Women 41.2%
25% ― Men 55.5%
200 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 62.6%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2014)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
21.9%
All ages 87% [78– >95%] 78% [69–88%] 59% [52–66%] (2014)
965 000 Voluntary medical male circumcisions
performed according to national standards 482 183
Children (0–14) 79% [65–93%] 79% [65–93%] 65% [54–77%]
(2018)
49 100
People who received PrEP at least once
3823
Women (15+) 88% [78– >95%] 83% [75–94%] 63% [56–71%] during the reporting period (2018)
584 000
Harm reduction
Men (15+) 87% [77– >95%] 69% [61–80%] 52% [46–60%]
332 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 71% >95% therapy
accessing antiretroviral medicines [56–84%] [94– >95%]
― Naloxone available (2019) No
33.5% 71.4%
Early infant diagnosis
[28.3–42.0%] [60.4–89.6%] ― Safe injection rooms available (2019) No

71
ZIMBABWE COUNTRY DATA

ZIMBABWE

EPIDEMIC ESTIMATES
2010 2015 2018
New HIV infections
62 000 44 000 38 000
New HIV infections (all ages)
[45 000–83 000] [32 000–59 000] [28 000–51 000]
15 000 6700 4800
New HIV infections (0–14)
[10 000–25 000] [4400–11 000] [3100–7900]
27 000 21 000 19 000
New HIV infections (women, 15+)
[19 000–36 000] [15 000–29 000] [14 000–26 000]
20 000 16 000 14 000
New HIV infections (men, 15+)
[14 000–27 000] [11 000–21 000] [10 000–19 000]

HIV incidence per 1000 population 5.65 [4.08–7.67] 3.46 [2.5–4.7] 2.79 [2.01–3.78]

AIDS-related deaths
54 000 24 000 22 000
AIDS-related deaths (all ages)
[43 000–68 000] [19 000–30 000] [17 000–27 000]
12 000 4900 3300
AIDS-related deaths (0–14)
[7600–18 000] [3100–7500] [2100–5000]
23 000 10 000 9700
AIDS-related deaths (women, 15+)
[18 000–29 000] [7900–13 000] [7600–12 000]
19 000 8900 9000
AIDS-related deaths (men, 15+)
[15 000–23 000] [7000–11 000] [7100–11 000]

People living with HIV


1 200 000 1 300 000 1 300 000
People living with HIV (all ages)
[1 100 000–1 400 000] [1 100 000–1 500 000] [1 100 000–1 500 000]
130 000 99 000 84 000
People living with HIV (0–14)
[99 000–160 000] [77 000–120 000] [65 000–100 000]
650 000 700 000 730 000
People living with HIV (women, 15+)
[560 000–740 000] [610 000–790 000] [630 000–830 000]
450 000 480 000 490 000
People living with HIV (men, 15+)
[390 000–520 000] [410 000–550 000] [420 000–560 000]
HIV prevalence (15–49) 15.4 [13.1–17.5] 13.8 [11.7–15.6] 12.7 [10.8–14.5]

LAWS AND POLICIES STIGMA AND DISCRIMINATION


Laws criminalizing the transmission of, non-
Yes Percentage of women and men aged 15–49 2011 2015
disclosure of or exposure to HIV transmission
years who report discriminatory attitudes
Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV
20.3 20.9
adults regulation of sex work

Percentage of people living with HIV denied 2014


Criminalization of same-sex sexual acts Yes, imprisonment (up to 14 years) health services because of their HIV status in
the last 12 months 6.3

Drug use or possession for personal use is an


... 2014
offence Percentage of people living with HIV who
reported a health-care professional told others
about their HIV status without their consent
Criminalization of transgender people Both criminalized and prosecuted 4.3

Laws or policies restricting the entry, stay and


residence of people living with HIV
No VIOLENCE
Parental consent for adolescents to access HIV Yes, for adolescents younger than
Proportion of ever-married or partnered 2011 2015
testing 16 years women aged 15–49 years who experienced
physical or sexual violence from a male
Spousal consent for married women to access
No intimate partner in the past 12 months 27.2 19.9
sexual and reproductive health services

Mandatory HIV testing for marriage, work or


Yes
residence permits or for certain groups

EXPENDITURES
Financing sources
International: International: International:
Domestic private Domestic public Total
PEPFAR Global Fund all others

Last available report: 2017 $78 163 197 $49 632 062 $53 659 112 $109 347 420 $127 169 812 $417 971 603

72
EPIDEMIC TRANSITION METRICS

200 000 200 000 10% 150 000


Number of people

Number of people

Number of people
150 000 8%
150 000
6% 100 000

Percent
100 000 100 000
4%
50 000
50 000 50 000
2%
0 0 0% 0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015
New HIV infections
Incidence:prevalence ratio
New HIV infections AIDS-related deaths
Target Deaths among people living
with HIV

Change in new Change in AIDS- Incidence:


Incidence:
HIV infections = -38% related deaths = -60% prevalence = 3% mortality ratio = 1.3
since 2010 since 2010 ratio

KEY POPULATIONS HIV COMORBIDITIES


Gay men and 23 000
other men People who Transgender
Estimated number of incident tuberculosis
Sex workers Prisoners [15 000
who have inject drugs people cases among people living with HIV (2017)
–33 000]
sex with men
People living with HIV who started TB
Estimated size of population ... ... ... ... ... 10.7%
preventive therapy (2017)
HIV prevalence 41.4% 31.0% ... ... 28.0%
Cervical cancer screening of women living
Know their HIV status 93.6% 50.0% ... ... 26%
with HIV (survey data) (2015)
Antiretroviral therapy coverage 71.9% 77.0% ... ... ...
People coinfected with HIV and hepatitis B
Condom use 96.1% ... ... ... ...
virus receiving combined treatment
Coverage of HIV prevention
44.0% 71.1% ... ...
programmes People coinfected with HIV and hepatitis C
...
virus starting hepatitis C treatment
Avoidance of health care
because of stigma and 39.3% ... ... ...
discrimination
HIV PREVENTION
Expenditures (0) ... ... ...
Adults aged 15+ years with unsuppressed
...
HIV TESTING AND TREATMENT CASCADE viral load

Knowledge of HIV prevention among young


1 400 000 100% people aged 15–24 years (2015)

1 200 000 ― Women 46.3%


Gap to
Number of people living with HIV

reaching the 75% ― Men 46.6%


1 000 000
first 90:
2000 Condom use at last sex with a non-marital,
800 000
50% non-cohabiting partner (2015)
600 000
― Women 66.7%
400 000
25% ― Men 85.4%
200 000
Women aged 15–49 years who have their
0 0% demand for family planning satisfied by 84.8%
People living with HIV who know People living with HIV on People living with HIV who are
modern methods (2015)
their status treatment virally suppressed
Men aged 15–49 years who are circumcised
14.3%
All ages 90% [78– >95%] 88% [77– >95%] ...% [...–...%] (2015)
1 151 000 Voluntary medical male circumcisions
performed according to national standards 326 012
Children (0–14) 76% [59–93%] 76% [59–93%] ...% [...–...%]
(2018)
63 900
People who received PrEP at least once
4982
Women (15+) 94% [81– >95%] 93% [81– >95%] ...% [...–...%] during the reporting period (2018)
680 000
Harm reduction
Men (15+) 86% [75– >95%] 83% [72– >95%] ...% [...–...%]
407 000 ― Use of sterile injecting equipment at
...
last injection
― Needles and syringes distributed per
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ...
person who injects
2010 2018 ― Coverage of opioid substitution
...
Percentage of pregnant women living with HIV 29% 94% therapy
accessing antiretroviral medicines [22–34%] [71– >95%]
― Naloxone available (2019) No
8.8% 63.0%
Early infant diagnosis
[7.4–11.7%] [52.8–83.2%] ― Safe injection rooms available (2019) No

73
TITLE OF THE ARTICLE

FIGURE 11.1 HIV prevalence among young women and men aged 20–29 years, western and central Africa,
WESTERN AND CENTRAL AFRICA

2012–2017

4
Per cent

Females Males Women Men

Source: Population-based surveys, 2012–2017.

10 74
UNAIDS DATA 2019

WESTERN AND
CENTRAL AFRICA

AT A GLANCE
Some national HIV Systemic barriers, Many countries Although HIV A priority issue
responses show including and communities prevalence across facing the region
improvement, HIV-related in the region are the region is is the extremely
but insufficient criminalization and fragile, affected by higher than 1% low coverage
political will, frail user fees, continue conflict, insecurity and therefore of antiretroviral
health systems to deter large and humanitarian considered to therapy among
and weak support numbers of people crises that create be a generalized children (28%).
for community from accessing additional barriers epidemic, key
organizations hold HIV testing and to HIV responses. populations
back progress. treatment services. and their sexual
partners accounted
for 64% of all new
infections within
the region.

Despite some progress and successes, the catch- and sexual and reproductive health services in many
up plans developed and implemented by western countries of the region, and the poor integration of
and central African countries have not sufficiently what services do exist.
accelerated the HIV response in the region.
Comprehensive programmes for the prevention of The adoption of differentiated models of care,
HIV infections among key populations and young including a greater role for communities, holds
women are especially lacking. HIV prevalence among promise in a region where health systems are
young women (aged 20–29 years) exceeds 3% in relatively weak. An encouraging development is the
five countries (Cameroon, the Congo, Côte d’Ivoire, UNAIDS-supported establishment of the Civil Society
Gabon and Liberia), and it is consistently higher than Institute for Health in West and Central Africa, which
it is among young men of the same age (Figure 11.0). aims to develop an effective and sustainable health
response in western and central Africa through
Every day, approximately 160 young women aged a regional mechanism for consultation, coordination
15–24 years become infected with HIV in the region. and synergy of civil society organizations working
This reflects a lack of gender-sensitive HIV services in the health sector.

75
WESTERN AND CENTRAL AFRICA

PART 1 | PART TITLE


STATE OF THE EPIDEMIC

FIGURE 11.2 Number of new HIV infections, Combination HIV prevention and treatment
western and central Africa, 2000–2018 programmes in western and central Africa are not
having sufficient impact on the region’s epidemic.
Percentage 700 000 Annual new HIV infections have declined by only
Number of new HIV infections

change in new
600 000 13% since 2010, from an estimated 320 000
HIV infections
since 2010 [210 000–480 000] to 280 000 [180 000–420 000]
500 000
(Figure 11.2). The annual number of AIDS-related
-13% 400 000

300 000
deaths decreased by 29% between 2010 and 2018,
from 230 000 [160 000–330 000] to 160 000
200 000 [110 000–230 000] (Figure 11.3). The region’s
incidence-prevalence ratio of 5.5% [3.7–8.3%] was
100 000
almost double the epidemic transition benchmark
0 of 3.0% (Figure 11.4).
2000

2010

2018
TITLE OF THE ARTICLE Three countries—Cameroon, Côte d’Ivoire and
New HIV infections Source: UNAIDS 2019 estimates.
Nigeria— account for close to 60% of new HIV
New HIV infections infections and 54% of AIDS-related deaths each
FIGURE 11.3 Number of AIDS-related deaths, year. Decisive improvements in their national HIV
western and central Africa, 2000–2018 programmes would have a major impact on the
region’s overall HIV response. The recent Nigeria
Percentage 500 000 AIDS Indicator and Impact Survey (NAIIS) found
Number of AIDS-related deaths

change in AIDS- 450 000 lower HIV prevalence than earlier surveys, which
related deaths 400 000 led to a revision of the country’s HIV estimates.
since 2010 350 000
The latest regional estimates reflect this additional

-29%
300 000
information, with lower estimates of people living
250 000
with HIV, AIDS-related deaths and HIV infections
200 000
150 000 than previous estimates.
100 000
50 000 Burkina Faso and Burundi have achieved impressive
0 declines in new HIV infections between 2010 and
2000

2010

2018

2018 (Figure 11.5). However, Equatorial Guinea, the


Gambia, Mali and Niger are lagging 1|
PART behind in their
PART TITLE
AIDS-related deaths Source: UNAIDS 2019 estimates. prevention efforts, with increases in new HIV infections
of greater than 10% between 2010 and 2018.
AIDS-related deaths

FIGURE 11.4 Incidence-prevalence ratio, western Key populations and their sexual partners
and central Africa, 2000–2018 accounted for 64% of all new HIV infections within
the region in 2018 (Figure 11.7). HIV prevalence
2018 14 among sex workers in individual countries ranged
Incidence-prevalence
12 from 4% to more than 30%, and it exceeded 10%
Incidence-prevalence ratio

ratio
10 in nine of the 17 countries reporting data (Figure

5.5% 8
11.6). Among gay men and other men who have
sex with men, median HIV prevalence was 13.7%
[3.7–8.3%] 6 in the 16 reporting countries, and it was more than
4 20% in six countries. The one study conducted
3 among transgender persons found HIV prevalence
2
of 15%, while HIV prevalence among people who
0 inject drugs and prisoners is also far higher than
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018

HIV prevalence in the overall adult populations


of  most countries.
Incidence-prevalence Target value

Source: UNAIDS 2019 estimates. Incidence-prevalence ratio

Target
76
UNAIDS DATA 2019

PART 1 | PART TITLE

FIGURE 11.5 Percentage change in new HIV infections, by country, western and central Africa, 2010–2018

60 51

40
30
20
20 11
5
Per cent

-9 -8
-20 -11
-15
-19 -18
-24 -22
-31 -31
-40 -34 -33 -31
-40 -39 -39
-49 -47
-60 -55

-80

Source: UNAIDS 2019 estimates.


TITLE OF THE ARTICLE TITLE OF THE ARTICLE

FIGURE 11.6 HIV prevalence among key populations, FIGURE 11.7 Distribution of new HIV infections
western and central Africa, 2014–2018 (aged 15–49 years), by population group,
western and central Africa, 2018
45
40
35 Sex workers
14%
30
Per cent

25 People who
inject drugs
20 15.3 8%
15 Remaining
13.7 population
10 10.0 36%
5 4.7
Gay men and
2.3
0 other men
who have sex
Sex workers (n = 17) with men
17%
Gay men and other men who have sex with men (n = 16)
Clients of sex workers and sex
People who inject drugs (n = 6) partners of other key populations
Transgender people (n = 1) 25%

Prisoners (n = 15)
Source: UNAIDS special analysis, 2019.
Source: Global AIDS Monitoring, 2014–2018.

77
TITLE OF THE
WESTERN ANDARTICLE
CENTRAL AFRICA

TITLE OF THE ARTICLE

TABLE 11.1 Estimated size of key populations, western and central Africa, 2018

FIGURE 11.9 HIV testing and treatment cascade, western and central Africa, 2018

cent of adult population (15+)

cent of adult population (15+)

Prisoners as per cent of adult


Gay men and other men who

Gay men and other men who

per cent of adult population


People who inject drugs as

Transgender people as per


Sex workers as per cent of
National adult population

have sex with men as per


6
Number of people living with HIV (million)

People who inject drugs


adult population (15+)

Transgender people
have sex with men
5

population (15+)
Sex workers
4 Gap to reaching
the first 90: Gap to reaching

Prisoners
Country

1.3 million the first and Gap to reaching


(15+)

(15+)
3 second 90s: the three 90s:
1.5 million 1.7 million
Cameroon 14 188 000
2
64% 51%
Côte d'Ivoire 14 375 000 4139%
000 0.29
[51–80%] [34–66%] [25–53%]
Democratic
1 Republic
45 227 000 350 000 0.77 190 000 0.43 160 000 0.34
of the Congo
Gambia
0 1 188 000
People
Mali living
10 026 000with HIV People living with HIV People living with HIV
who know their status on treatment who are virally suppressed
Niger 11 130 000
Source: UNAIDS special analysis, 2019; see annex on methods for more details.
Senegal 9 332 000 3100 0.03 9500 0.10
Togo 4 691 000 5200 0.11

National population size estimate Local population size estimate Insufficient data No data

The regions to which the local population size estimate refers:


Gambia (Banjul)

Sources: Global AIDS Monitoring, 2018; United Nations, Department of Economic and Social Affairs, Population Division. World
population prospects: the 2017 revision. 2018 (custom data acquired via website).

FIGURE 11.8 Viral load suppression among adults (aged 15 years and older) living with HIV, by sex, western
and central Africa, 2018

100
90
80
70
60
Per cent

50
40
30
20
10
0
Benin Cabo Verde Côte d'Ivoire Niger Sao Tome and Sierra Leone
Principe
Women Men
Females Males Source: UNAIDS special analysis, 2019.

7 78

6
UNAIDS DATA 2019

THE CASCADE FROM HIV TESTING TO VIRAL


SUPPRESSION

Among the estimated 5 million [4.0 million–6.3 million] challenge is the diagnosis of people living with HIV.
people living with HIV in western and central Africa Besides Cabo Verde, no country in the region has
in 2018, the proportion who knew their HIV status achieved the first 90. Cabo Verde, the Democratic
increased from 51% [41–64%] in 2015 to 64% [51–80%] Republic of the Congo, Mali and Senegal have reached
in 2018 (Figure 11.9). Access to HIV testing and the second 90, and several other countries are very
treatment reached 51% [34–66%] of people living close to doing the same (Table 11.2).
with HIV in 2018, up from 37% [26–48%] in 2015. The
estimated percentage of people living with HIV in An important gap in the HIV response in the region is
the region who had suppressed viral loads was 39% the provision of antiretroviral therapy to children living
[25–53%] in 2018. Achieving all three 90s requires viral with HIV. Only 28% [18–39%] of children living with
load suppression among an additional 1.7 million HIV accessed treatment in 2018, which is considerably
people living with HIV. lower than the 59% [47–71%] of pregnant women who
received treatment in the region.
Progress toward the 90–90–90 targets in the region is
slow, with 79% [70–83%] of people who know their HIV Due to hostile legal and social environments, people
status receiving treatment. Viral suppression among belonging to key populations are often apprehensive
those on treatment is 76% [56–87%]. This means that about (and distrustful of) standard testing and treatment
the gap in 2018 to achieving the first of the 90–90–90 services. A recent study from Burundi, Côte d’Ivoire
targets was 1.3 million people who did not know they and the Democratic Republic of the Congo found that
were living with HIV. enhanced peer outreach approaches led to higher
proportions of new HIV diagnoses among both female
Although weaknesses exist along the entire continuum sex workers and gay men and other men who have sex
of testing and treatment services, the single biggest with men (1).
TITLE OF THE ARTICLE

FIGURE 11.9 HIV testing and treatment cascade, western and central Africa, 2018

6
Number of people living with HIV (million)

4 Gap to reaching
the first 90: Gap to reaching
1.3 million the first and Gap to reaching
3 second 90s: the three 90s:
1.5 million 1.7 million

2
64% 51% 39%
[51–80%] [34–66%] [25–53%]
1

0
People living with HIV People living with HIV People living with HIV
who know their status on treatment who are virally suppressed

Source: UNAIDS special analysis, 2019; see annex on methods for more details.

79
WESTERN AND CENTRAL AFRICA PART 1 | PART TITLE

TABLE 11.2 90–90–90 country scorecard, western and central Africa, 2018

First 90: percentage Second 90: Third 90: percentage Viral load
of people living with percentage of of people living suppression:
HIV who know their people living with with HIV on percentage of
HIV status HIV who know their treatment who have people living with
status and who are suppressed viral HIV who are virally
on treatment loads suppressed

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)

All ages

Women (15 years


and older)

Men (15 years


and older)
Western and central Africa 64 71 61 79 86 66 76 78 75 39 48 30
Benin 79 79 79 48 61 30
Burkina Faso 70 82 63 88 >95 73
Burundi
Cabo Verde >95 92 47 58 36 42 54 29
Cameroon 74 80 75 71 74 63
Central African Republic 55 62 53 65 71 53
Chad
Congo 39 43 36 89 84 >95
Côte d'Ivoire 63 72 53 87 92 74 75 77 74 41 51 29
Democratic Republic of the Congo 62 64 79 92 91 93
Equatorial Guinea 49 64 40 69 83 44
Gabon
Gambia 36 46 22 81 81 75
Ghana 57 69 43 59 58 58
Guinea
Guinea-Bissau
Liberia 68 85 54 52 53 46
Mali 33 37 33 93 95 87
Mauritania 62 77 53 88 >95 77
Niger 72 85 62 75 81 63 83 84 84 45 58 33
Nigeria 67 74 63 80 92 60 80 42
Sao Tome and Principe 41 45 38 31 48 20
Senegal 65 74 60 >95 >95 >95
Sierra Leone 49 61 38 83 86 74 63 64 61 26 34 17
Togo 73 84 69 82 87 71

90–90–90: 90% and above 85–89% 70–84% 50–69% Less than 50%
Viral load suppression: 73% and above 65–72% 40–64% 25–39% Less than 25%

Source: UNAIDS special analysis, 2019.

80 2
UNAIDS DATA 2019

A COMBINATION APPROACH TO PREVENTION

Condom promotion remains a mainstay of prevention FIGURE 11.10 Percentage of key populations who
programmes in the region. However, in 12 countries reported receiving at least two prevention services
with recent data from a population-based survey, only in the past three months, western and central
six indicated that more than half of young men (aged Africa, 2016–2018
15–24 years) reported condom use at last high-risk
100
sex. They also reported condom use among young
90
women was consistently lower (Figure 11.11).
80
70

Per cent
Few data are available on the coverage of 60
combination prevention services for key populations 50
in the region (Figure 11.10), with high HIV prevalence 40
among these population suggesting that coverage is 30
low in many countries. Senegal is a rare example of 20
a country in the region providing both needle–syringe 10
programmes and opioid substitution therapy to 0
Burkina Côte Guinea Niger* Sao Senegal
people who inject drugs (2). Faso d'Ivoire Tome
and
Key populations rely chiefly on civil society Principe
organizations for prevention services, which often
Sex workers Gay men and other men having sex with men
operate in unwelcoming environments. The reform
Sex workers
People who inject drugs Transgender people
of obstructive laws and legal policies—along with
greater funding and other support for community- Gay men
Note: The useand other
of an men who
asterisk have sexthat
(*) indicates withdata for marked
based organizations—would greatly enhance HIV men come from programme data (which tend to show
countries
prevention focused on key populations. higher values due to the use as a denominator of the number
of key population members that are linked to the programme)
and not from a survey.
The latest World Health Organization (WHO)
guidelines have highlighted pre-exposure prophylaxis Possible prevention services received among sex workers, gay
(PrEP) as an important tool to prevent new infections men and other men who have sex with men and transgender
people: condoms and lubricant, counselling on condom use
among people at substantial risk of HIV infection, and safe sex, and testing for sexually transmitted infections.
but the region has been slow in adopting these Possible prevention services received among people who
guidelines. Two regional projects are underway: inject drugs: condoms and lubricant, counselling on condom
use and safe sex, and clean needles or syringes.

• A demonstration project in Burkina Faso, Côte Source: Global AIDS Monitoring, 2016–2018.
d’Ivoire, Mali and Togo is evaluating the feasibility
of rolling out PrEP nationally and regionally. The
project is financed by the French National Agency
for Research on AIDS and Expertise France,
in partnership with Coalition PLUS and three
European health institutes.

• An implementation project in Côte d’Ivoire, the


Democratic Republic of the Congo and Nigeria
is supported by the United States President’s
Emergency Plan for AIDS Relief (PEPFAR).

81
WESTERN AND CENTRAL AFRICA

FIGURE 11.11 Percentage of men and women (aged 15–24 years) reporting use of a condom at last
high-risk sex (with a nonmarital, noncohabiting partner) in the past 12 months, western and central Africa,
2013–2017

70

60

50
Per cent

40

30

20

10

Males Females Source: Population-based surveys, 2013–2017.

Males Females

SUPPORTING PEOPLE WITH DISABILITIES

People with disabilities are often left behind FIGURE 11.12 HIV prevalence among people
by HIV responses. In western and central with disabilities compared to the general
Africa, biobehavioural surveys of people population, selected countries, western and
with disabilities were undertaken between central Africa, 2016–2018
8
2016 and 2018 in Burkina Faso, Cabo Verde,
Guinea-Bissau and Niger, while a broader 10
9
biobehavioural survey was conducted in
8
Senegal. They found that HIV prevalence is
7
on average three times higher among people
6
Per cent

with disabilities than it is among the general 5


population (Figure 11.12) (5). In Burkina Faso, 4
Guinea-Bissau and Senegal, women with 3
disabilities were considerably more likely to be 2
HIV-positive than men with disabilities (4–7). 1
0
Burkina Cabo Guinea Niger Senegal
The Regional HIV and Disability Project is Faso Verde Bissau
working to make regional and national HIV
laws, strategies and policies more inclusive of General population People with disabilities
people with disabilities. The project—established Women with disabilities Men with disabilities
General population
by Humanity & Inclusion and the West Africa People with disabilities
Source: Global Fund to Fight AIDS, Tuberculosis and Malaria,
Federation of Associations of People with Women with disabilities
Humanity & Inclusion, West Africa Federation of Persons with
Disabilities, with support from the Global Fund Disabilities. Une population oubliée: résultats des études bio
to Fight AIDS, Tuberculosis and Malaria (the comportementales [A forgotten population: results from the
Global Fund)—is collating information and good biobehavioural studies]. Power Point presentation. 2019.

practices around HIV-related and health facility


care for people with disabilities (3). It also seeks
to increase capacity and knowledge among civil
society organizations, policy-makers, and other
HIV and human rights stakeholders (4).

82
UNAIDS DATA 2019

ELIMINATING MOTHER-TO-CHILD TRANSMISSION

Western and central Africa’s faltering HIV response is FIGURE 11.13 Cascade of services for preventing
also reflected in the continuing high rate of mother- vertical transmission, numbers of new HIV
to-child transmission, which was an estimated 22% infections and transmission rate, western and
[19–26%] in 2018. Approximately 58 000 children central Africa, 2018
(aged 0–14 years) acquired HIV in 2018; of those,
41% lived in Nigeria, the country with the highest 300 000
HIV burden in the region.
250 000

Number
Antiretroviral therapy coverage for pregnant women 200 000 59%
in the region has been declining since 2016, reaching [42–78%]
59% [42–78%] in 2018 (Figure 11.13). This means 150 000
Transmission
27%
that only 153 000 of the estimated 260 000 pregnant 100 000 [21–39%]
rate: 22%
[19–26%]
women living with HIV were receiving antiretroviral
medicine for preventing mother-to-child transmission. 50 000
In Nigeria, the number of women receiving
0
antiretroviral therapy during pregnancy decreased

age

infections
women

transmission
towomen
HIV

Women receiving
antiretrovirals to
vertical
prevent verticaltransmission

by
ofage

childinfections
withHIV

testedby
from 60 000 in 2014 to 44 000 between 2010 and

Infantstested
weeksof
living with

Women receiving
prevent to
2018, with treatment coverage diminishing from 63%

eight weeks
antiretrovirals
Birthsto
living
[41–89%] to 44% [28–62%] over the same period.1

Newchild
Births

Infants

New
Early infant diagnosis is another programming area
awaiting substantial improvement. Only 27% [21–39%] Any birth to women living with HIV
of infants exposed to HIV were tested for HIV infection
Children newly infected with HIV
within eight weeks of birth. The expansion and closer
Any birth to women living with HIV
integration of HIV, maternal and child health, and Source: UNAIDS 2019 estimates; 2019 Global AIDS Monitoring.
sexual and reproductive health services are urgently Children newly infected with HIV
needed to curb new HIV infections in children and
protect the health of mothers living with HIV.

“STIGMATIZING ATTITUDES
AND DISCRIMINATORY
BEHAVIOUR— INCLUDING
FROM HEALTH-CARE
WORKERS—AND
THE POLITICAL AND